Shortage Of Personal Protective Equipment Research Articles

Pandemic Makers: How Citizen Groups Mobilized Resources to Meet Local Needs in a Global Health Crisis

The enormous scale of suffering, breadth of societal impact, and ongoing uncertainty wrought by the COVID-19 pandemic introduced dynamics seldom examined in the crisis entrepreneurship literature. Previous research indicates that when a crisis causes a failure of public goods, spontaneous citizen ventures often emerge to leverage unique local knowledge to rapidly customize abundant external resources to meet immediate needs. However, as outsiders, emergent citizen groups responding to the dire shortage of personal protective equipment at the onset of COVID-19 lacked local knowledge and legitimacy. In this study, we examine how entrepreneurial citizens mobilized collective resources in attempts to gain acceptance and meet local needs amid the urgency of the pandemic. Through longitudinal case studies of citizen groups connected to makerspaces in four U.S. cities, we study how they adapted to address the resource and legitimacy limitations they encountered. We identify three mechanisms—augmenting, circumventing, and attenuating—that helped transient citizen groups calibrate their resource mobilization based on what they learned over time. We highlight how extreme temporality imposes limits on resourcefulness and legitimation, making it critical for collective entrepreneurs to learn when to work within their limitations rather than try to overcome them.

The Unprecedented Role of 3D Printing Technology in Fighting the COVID-19 Pandemic: A Comprehensive Review.

The coronavirus disease 2019 (COVID-19) rapidly spread to over 180 countries and abruptly disrupted production rates and supply chains worldwide. Since then, 3D printing, also recognized as additive manufacturing (AM) and known to be a novel technique that uses layer-by-layer deposition of material to produce intricate 3D geometry, has been engaged in reducing the distress caused by the outbreak. During the early stages of this pandemic, shortages of personal protective equipment (PPE), including facemasks, shields, respirators, and other medical gear, were significantly answered by remotely 3D printing them. Amidst the growing testing requirements, 3D printing emerged as a potential and fast solution as a manufacturing process to meet production needs due to its flexibility, reliability, and rapid response capabilities. In the recent past, some other medical applications that have gained prominence in the scientific community include 3D-printed ventilator splitters, device components, and patient-specific products. Regarding non-medical applications, researchers have successfully developed contact-free devices to address the sanitary crisis in public places. This work aims to systematically review the applications of 3D printing or AM techniques that have been involved in producing various critical products essential to limit this deadly pandemic’s progression.

The Government's Legal Responsibility in Fulfilling Personal Protective Equipment for Doctors during the Covid-19 Pandemic.

The high rate of Covid-19 infection that occurs today requires the fulfillment of health facilities for doctors and health workers, especially Personal Protective Equipment (PPE) in handling patients during the Covid-19 pandemic. PPE shortages were widely reported in some health care facilities in various regions. Not only in privately owned health service facilities, government hospitals and community health centers are also not spared from experiencing limited PPE. This Study discusses how the Government's Legal Responsibility Arrangements in Fulfilling PPE for Doctors amidst the Covid-19 Pandemic. This study used normative legal as its research method. The results of this study indicated that there are no specific arrangements that regulate the government's responsibility in providing PPE for Doctors during the Covid-19 period. The government's responsibility for providing PPE for Doctors amidst the covid-19 period was a form of main responsibility. But it was still not done well. Ideally, the government’s responsibility in fulfilling physicians’ rights to health has emerged in accordance with the standards set by WHO in the form of providing appropriate personal protective equipment. It was important to Special monitoring is needed regarding the availability of existing PPE in the form of quantity and quality so that the safety and health rights of doctors can be fulfilled.

Management of Personal Protective Equipment Shortage and Other Medical Resources during the COVID-19 Pandemic

At the beginning of the COVID-19 pandemic, there had been a profound shortage of personal protective equipment (PPE) and other medical resources over the world, leaving healthcare personnel (HCP) in danger. The medical supply crisis, including oxygen shortage, still exists in some low-income countries. The article describes the experience in the management of PPE and rescheduling medical procedures in a hospital while battling COVID-19 and also maintaining necessary medical care, including training and guiding PPE use, triaging patients, and rescheduling daily services in ophthalmology and ENT department with high-risk exposure.

A Multi-center Retrospective Analysis of Healthcare Workers after COVID-19: Epidemiological and Clinical Features

Objective: Concerns regarding the high-level risk of infection among healthcare workers (HCWs) increased after COVID19 was declared as a pandemic in March 2020. Inadequate infection control owing to a shortage of personal protective equipment or an inconvenient usage of infection control measures may play a significant role in transmission to/among healthcare personnel. The study aimed to determine the characteristics and outcomes of COVID-19 patients who are healthcare workers along with possible transmission routes of COVID-19 in four different healthcare facilities in Istanbul. 
 Methods: All hospital records were reviewed retrospectively. Demographic and clinical characteristics of HCWs were documented, and all infected HCWs were subjected to a phone-based mini-questionnaire and three-dimensional test (TDT). All statistical analyses were done using statistical packages SPSS Demo Ver 22 (SPSS Inc. Chicago, IL, USA). 
 Results: Clinical features of COVID-19 were similar to the general public’s characteristics. The most frequent symptoms were cough, fever, and headache. HCWs with the O blood group tend to have asymptomatic COVID-19 infection. Hospital workers other than medical professionals have a lack of convenience of infection control measures. The median duration of PCR negativity was 9 days. HCWs who had a sore throat at the beginning of COVID-19 have a longer PCR-positive duration. 
 Conclusion: Understanding the clinical features or characteristics of asymptomatic COVID-19 carriers may aid in the implementation of a feasible screening program for early detection. It is strongly advised that proper infection control precautions, education, and auditing of nonclinical staff be implemented. As a result, transmission among healthcare workers can be avoided.

Crowdsourcing homemade facemasks: 772 U.S. health facilities' responses to personal protective equipment shortages in the first half of 2020.

PurposeWe examined 772 U.S. health facilities' responses to Personal Protective Equipment (PPE) shortages in the first half of 2020, as they crowdsourced face coverings from volunteer makers to be used as respiratory protection during crisis surge capacity. The purpose was to examine facemask specification requests from health facilities and develop a framework for crowdsourcing last resort PPE.Design/methodology/approachHomemade facemask donation requests from health facilities in 47 states systematically recorded in a public database maintained by public health graduate students at a major U.S. university were analysed. Open coding was used to content analyse facemask types and specifications, intended uses, delivery logistics and donation management strategies.FindingsOur analysis revealed information gaps: Science‐based information was scarce in 2020, leading to improvised specifications for facemask materials and designs. It also revealed the emergence of a crowdsourcing structure: Task specifications for volunteer facemasks makers, delivery logistics, and practical management of donations within the pandemic context. In anticipation of future pandemics and localised PPE shortages, we build on this empirical evidence to propose a framework for crowdsourcing science‐informed facemasks from volunteers. Categorised within (a) logistics and workflow management, (b) task specifications and management, and (c) practical management of contributions functional areas, the framework outlines the required tasks and specifications for crowdsourcing.OriginalityA novel empirically derived framework for crowdsourcing homemade facemasks is proposed, based on empirical analysis and crowdsourcing system design strategies. Our findings and the framework may be used for refining crisis capacity guidelines, as part of strategic planning and preparation for future pandemics that disrupt supply chains and cause shortages in protective equipment.

The Impact of COVID-19 Crisis on the Control and Management of Radiography Practice in the United Arab Emirates

The present study aimed to assess the impact of the COVID-19 crisis on radiology practices in Abu Dhabi, UAE. An electronic survey (Google form) was distributed among Abu Dhabi government and private hospitals. The survey included general X–ray services, which were only provided in the radiology departments. The diagnostic radiographers who reported changes in the number and type of radiology procedures (37%) reported that the changes reached 61–80% compared to the number of procedures being conducted prior to the outbreak of COVID-19. While infection control was challenging due to the shortage of personal protective equipment (PPE), 51.2% of the participants were affected. The healthcare workers in the radiology departments in Abu Dhabi are exposed to a high number of COVID-19–infection patients, which increases their chances of contracting the disease. A total of 90% of employees were infected with COVID-19 during the crisis. COVID-19 has resulted in changes in clinical working patterns, such as the type and number of procedures performed daily. Additionally, PPE shortages, staff infection during the pandemic, an increase in workplace–related difficulties, and staff well–being are common consequences of the pandemic. It is vital to enhance coping strategies in order to support staff well–being. However, the psychological effects caused as a result of the pandemic should not be ignored, and providing professional support to workers is recommended.

Fieldwork for public health responses during pandemics: lessons from the New South Wales Health experience with COVID-19

Problem: Fieldwork is a vital component of public health emergency response, yet little has been published on undertaking fieldwork safely. Safety is of particular importance with emerging pandemic viruses, which can pose additional risks to public health fieldwork staff. Context: During a pandemic, surge health staff may be drawn from diverse professional backgrounds; they may have limited experience in fieldwork or be unfamiliar with the risks posed by a novel virus. Novel pathogens pose dangers to fieldwork staff, particularly when there are global or local shortages of personal protective equipment. Action: During the coronavirus disease 2019 (COVID-19) pandemic, New South Wales (NSW) Health’s Public Health Emergency Operations Centre (PHEOC) deployed staff for fieldwork in a range of settings. The PHEOC developed a protocol to systematize planning, risk assessment and management for COVID-19 fieldwork. The protocol was accompanied by training, discussion exercises and debriefs to support PHEOC fieldwork staff. Lessons learned: Effective fieldwork is an essential component of outbreak investigation and management, including stakeholder management. Here, we share and discuss key elements of the NSW Health protocol to support fieldwork during outbreak responses for emerging communicable diseases across various resource contexts. Limited understanding of novel viruses, particularly in the early phases of a pandemic, must be considered in decisions to deploy fieldwork staff and implement precautionary risk mitigation approaches. Planning is essential to protect staff and ensure ethical allocation of resources. Through appropriate selection of teams and training, surge staff can be supported to effectively conduct fieldwork.

Early Response to COVID-19

Early Response to COVID-19

Examining the discourse regarding the delivery of occupational infection prevention and control training to healthcare workers: a scoping review of pandemic plans of 23 countries

BackgroundOver the years, countries reformed their pandemic plans but still healthcare systems were unprepared to handle the COVID-19 pandemic. Throughout the COVID-19 pandemic, healthcare workers (HCWs) raised issues around shortage...

Assessment of the Functional Capacity and Preparedness of the Haitian Healthcare System to Fight against the COVID-19 Pandemic: A Narrative Review

Low-income countries, such as Haiti, are facing challenges in fighting the COVID-19 pandemic due to resource shortages and fragile healthcare systems. This study assessed the functional capacity and preparedness of the Haitian healthcare system regarding the COVID-19 pandemic. It employed a narrative review approach to analyze secondary data and used the Donabedian model and the global health security index as the theoretical frameworks to evaluate preparedness. The findings reveal that Haiti faces challenges in tackling the COVID-19 pandemic due to a lack of biosafety and biosecurity regulations, inadequate laboratory systems for COVID-19 testing, and shortages of human resources and personal protective equipment. Moreover, poverty remains widespread, and people lack access to clean water and sanitation services, resulting in a high risk of COVID-19 infection. Furthermore, a lack of communication, rumors, the circulation of fake news regarding COVID-19, and stigmatization cause distrust and reduce the number of people seeking healthcare services. Haiti faces challenges with respect to tackling the pandemic. The Haitian government can strengthen and improve the capacity of the healthcare system to fight against the COVID-19 pandemic and infectious diseases emerging in the future.

Methylene blue applied to N95 respirators and medical masks for SARS-CoV-2 decontamination: What is the likelihood of inhaling methylene blue?

BackgroundGlobal shortage of personal protective equipment (PPE), as consequence of the COVID-19 global pandemic, has unmasked significant resource inequities prompting efforts to develop methods for safe PPE decontamination for reuse. The World Health Organization (WHO) in their Rational Use of PPE bulletin cited the use of a photodynamic dye, methylene blue, and light exposure as a viable option for N95 respirator decontamination. Because WHO noted that methylene blue (MB) would be applied to surfaces through which health care workers breathe, we hypothesized that little to no MB will be detectable by spectroscopy when the PPE is subjected to MB at supraphysiologic airflow rates.MethodsA panel of N95 respirators, medical masks, and cloth masks were sprayed with 5 cycles of 1,000 uM MB solution. Mask coupons were subjected to the equivalent of 120 L/min of 100% humidified air flow. Effluent gas was trapped in an aqueous solution and the resultant fluid was sampled for MB absorbance with a level of detection of 0.004 mg/m3.ResultsNo detectable MB was identified for any mask using Ultraviolet-Visible spectroscopy.ConclusionsAt 500-fold the amount of MB applied to N95 respirators and medical masks as were used for the decontamination study cited in the WHO Rational Use of PPE bulletin, no detectable MB was observed, thus providing safety evidence for the use of methylene blue and light exposure for mask decontamination.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Ozone treatment effectively eliminates SARS-CoV-2 from infected face masks.

The current COVID-19 pandemic is causing profound health, economic, and social problems worldwide. The global shortage of medical and personal protective equipment (PPE) in specialized centers during the outbreak demonstrated the need for efficient methods to disinfect and recycle them in times of emergency. We have previously described that high ozone concentrations destroyed viral RNA in an inactivated SARS-CoV-2 strain within a few minutes. However, the efficient ozone dosages for active SARS-CoV-2 are still unknown. The present study aimed to evaluate the systematic effects of ozone exposure on face masks from hospitalized patients infected with SARS-CoV-2. Face masks from COVID-19 patients were collected and treated with a clinical ozone generator at high ozone concentrations in small volumes for short periods. The study focused on SARS-CoV-2 gene detection (assessed by real-time quantitative polymerase chain reaction (RT-qPCR)) and on the virus inactivation by in vitro studies. We assessed the effects of different high ozone concentrations and exposure times on decontamination efficiency. We showed that high ozone concentrations (10,000, 2,000, and 4,000 ppm) and short exposure times (10, 10, and 2 minutes, respectively), inactivated both the original strain and the B.1.1.7 strain of SARS-CoV-2 from 24 contaminated face masks from COVID-19 patients. The validation results showed that the best condition for SARS-CoV-2 inactivation was a treatment of 4,000 ppm of ozone for 2 minutes. Further studies are in progress to advance the potential applications of these findings.

Aerosol boxes for airway management in coronavirus disease patients: a clinical retrospective study in Mexico

IntroductionSignificant concerns raise for the healthcare workers involved in airway management of patients diagnosed with coronavirus 2019 disease (COVID-19).Due to shortages of personal protective equipment (PPE), barrier enclosure systems such as aerosol box (AB) have been proposed worldwide. The aim of this study was to evaluate our experience using AB as protective equipment in patients with COVID-19 in a third-level center in Mexico.MethodsA retrospective study of COVID-19 patients requiring airway management using an AB in the Hospital Central Sur de Alta Especialidad de Pemex in Mexico City from March 1 to June 1, 2020. Antropometric data, pre-intubation vital signs, and laboratory tests were recorded; the primary endpoints were intubation success rate and complications associated with AB and patients’ mortality. As a secondary endpoint, AB subjective evaluation was explored by administering a survey after airway management procedures.ResultsThirty-nine patients for a total of 40 intubations were documented. Thirty-one (77.5%) were men, with a mean age of 61.65 years; successful intubation occurred in 39 (97.55%) of the procedures, and AB was used in 36 (90%) of intubations, with success in 28 (70.0%); A Cormack-Lehane grade 3 view was recorded in 18 patients (46.2%), and during the procedure, the AB had to be removed in 8 (22.2%) cases, with migration documented in 91.6% of cases. The 30-day mortality was 48.71%, with 23.0% of patients discharged. 83.3% of surveyed anesthesiologists reported significant limitations in manipulating airway devices with AB used.ConclusionOur data indicate that in clinical practice, the use of AB may hinder airway management and decrease the intubation success rate and may also result in patients’ injury. Further studies are necessary to validate the use of AB in clinical practice, and they should not replace certified PPE.

Personal protective equipment market coordination using subsidy.

During a pandemic, various resources, including personal protective equipment (PPE), are required to protect people and healthcare workers from getting infected. Due to the high demand and limited supply chain, countries experience a shortage in PPE products. This global crisis imposes a decline in the international trade of PPE supplies. In fact, most governments implement a localization strategy motivating domestic manufacturers to pivot their operations to respond to PPE demands. An oligopolistic market cannot reach the socially optimal coverage without government subsidies. On the other hand, the government subsidy pays the proportion of production costs to reach the socially optimal coverage, while the government’s budget is limited. Therefore, the government collaborates with manufacturers via procurement contracts to increase the supply of PPE products. We propose the first supply chain model of PPE products that investigates manufacturer costs and government expenditure. We consider how different behavioral aspects of manufacturers and government can self-organize towards a system optimum. Additionally, we integrate the consumer surplus, producer surplus, and societal surplus into the game model to maximize social benefit. A cost-sharing contract under the system optimum between government and manufacturers is designed to increase the production of PPEs and hence, helps in reducing the number of infected individuals. We conducted our computational study on real data generated from the mask usage during the Covid-19 pandemic in Los Angeles (LA) County to respond to the reported PPE shortage. Under the socially optimal strategy, the PPE coverage increases by up to 33%, and the number of infected individuals reduces by up to 30% compared to other strategies.

Overcoming Barriers to Kangaroo Care in a Metropolitan NICU During the COVID-19 Pandemic

Overcoming Barriers to Kangaroo Care in a Metropolitan NICU During the COVID-19 Pandemic

Mitigating personal protective equipment (PPE) supply chain disruptions in pandemics – a system dynamics approach

PurposeThe coronavirus disease (COVID-19) pandemic has emerged as an unprecedented health crisis worldwide and heavily disrupted the healthcare supply chain. This study focuses on analysing the different types of disruptions occurring in personal protective equipment (PPE) supply chains during the COVID-19 pandemic and on proposing mitigation strategies that are fit to the global scale and many interdependencies that are characteristic for this pandemic. The authors construct a conceptual system dynamics model (SD) based on the literature and adjusted with the use of empirical data (interviews) to capture the complexity of a global supply chain and identify leverage points (mitigation strategies).Design/methodology/approachThis research follows a mix-methods approach. First, the authors developed a conceptual framework based on four types of disruptions that usually occur during health emergencies (direct effect, policy, supply chain strategy, and behaviourally induced disruptions). Second, the authors collected and analysed data from interviews with experts in the PPE supply chain. Based on the interviews data, the authors developed a conceptual system dynamics (SD) model that allows to capture the complex and dynamic interplay between the elements of the global supply chain system, by highlighting key feedback loops, delays, and the way the mitigation strategies can impact on them. From this analysis, the authors developed four propositions for supply chain risk management (SCRM) in global health emergencies and four recommendations for the policy and decision makers.FindingsThe SD model highlights that without a combination of mitigation measures, it is impossible to overcome all disruptions. As such, a co-ordinated effort across the different countries and sectors that experience the disruptions is needed. The SD model also shows that there are important feedback loops, by which initial disruptions create delays and shortages that propagate through the supply chain network. If the co-ordinated mitigation measures are not implemented early at the onset of the pandemic, these disruptions will be persistent, creating potential shortages of PPE and other critical equipment at the onset of a pandemic – when they are most urgently needed.Originality/valueThis research enriches the understanding of the disruptions of PPE supply chains on the systems level and proposes mitigation strategies based on empirical data and the existing literature.

Perceived Stress, Anxiety and Depression and its Associated Factors During COVID-19 Pandemic among Healthcare Workers in COVID-19 Health Facilities in Mogadishu Somalia

Coronavirus disease 2019 (abbreviated “COVID-19”) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The rapid spread of the disease created challenges for healthcare systems and forced healthcare workers to grapple with clinical and nonclinical stressors, including shortages of personal protective equipment, mortality and morbidity associated with COVID-19, fear of bringing the virus home to family members, and the reality of losing colleagues to the disease. Objective: This study was cried out to find-out the perceived anxiety, depression, stress as well as their associated factors among healthcare workers in COVID-19 health facilities in Mogadishu Somalia. Methods: The study was cross-sectional, descriptive analysis involving all healthcare workers in COVID-19 health facilities in Mogadishu Somalia namely Demartino hospital, Benadir hospital and Dr Summait hospital. The calculated sample size was 168 using slovin formula since the target population was known from the staff registration book, candidates were selected through systematic random sampling from each hospital in accordance with their proportion in the total population. Results: Anxiety was perceived mostly among respondents since only 30.7% were in normal level however only 10.7% had sever anxiety while stress was perceived the least since only 84.8% of participants were normal. Female participants were much more likely to have anxiety and stress, working department was also related with level of perceived anxiety, depression or stress; participants working at ICU and emergency were the most to have anxiety or stress compared to others. Conclusion: Perceived anxiety was the highest while only 1.1% of respondents had severe stress. Female gender as well as working departments was signifactly associated with the level of Anxiety and stress while average income, motivation and living condition was associated with depression.

Capitalizing on a Global Personal Protective Equipment (PPE) Shortage to Design a More Functional and Sustainable Isolation Gown

BackgroundThe COVID-19 pandemic caused a global PPE shortage. Across our health system, the type of disposable isolation gowns we were accustomed to using were not as readily available. As a result, we used new varieties of isolation gowns of inconsistent quality. With isolation gowns being the second most used type of PPE at our organization, we used and disposed of almost 3.1 million single-use isolation gowns, amounting to approximately 213 tons of waste in a year. An opportunity arose to design and implement a consistently high quality and reusable isolation gown that would both be protected from supply chain disruptions and reduce our health system's ecological footprint.MethodsAfter trialing several varieties of disposable and reusable gowns, a substantial amount of feedback was gathered over several months from end-users, Infection Prevention, and Supply Chain. This feedback informed the design of a custom reusable isolation gown that resolves identified problems in functionality, particularly barrier effectiveness, comfort, fit, and ease of donning and doffing. The new design meets current healthcare protection clothing standards and specifications.ResultsThe custom reusable isolation gowns are being implemented at all hospitals across our health system. There is adequate supply of the reusable gowns, as the product is not susceptible to PPE shortages. There is overwhelmingly positive feedback from end-users on functionality and effectiveness. The gowns are safely laundered according to healthcare standards, resulting in less waste when compared to single-use isolation gowns.ConclusionsPPE shortages leave frontline healthcare workers ill-equipped to care for patients. Design and implementation of a more functional and sustainable product, that is not vulnerable to supply chain disruptions, helps ensure our healthcare workers have the resources needed to protect themselves and others from spreading infectious pathogens.