Standard Personal Protective Equipment Research Articles

HEALTH RISK ASSESSMENT OF PESTICIDE EXPOSURE IN FARMERS AROUND RICE FARMING AREA IN OGAN ILIR REGENCY, SOUTH SUMATRA, INDONESIA

Introduction: Pesticides are chemical compounds that are toxic to the environment and humans. Approximately 89.8% of farmers in South Sumatra use chemical pesticides. Aims: This study aims to analyze the health risks due to pesticide exposure among farmers residing in rice farming areas. Methods: This study used an analytical observational design with a cross-sectional approach and was conducted in Pemulutan Subdistrict, Ogan Ilir Regency, from October 2020 to January 2021. The sample size consisted of 61 randomly selected respondents. Blood test samples were taken and examined at the Palembang Health Laboratory Center. The cholinesterase was examined using the DGKC colorimetric (KINETIC) method. Independent t-test and multiple linear regression test were used to analyze the data. Results: The results of the analysis showed that the average cholinesterase level in the blood serum of the farmers was 7628.40 U/L. This study also found that 83.6% of the farmers did not use complete and standard personal protective equipment. The variables that were significantly associated with cholinesterase levels in the blood of the farmers were age group and length of farming. Length of farming was identified as a predictor variable. Conclusion: Pesticides used by farmers in rice farming areas vary widely, ranging from slightly to extremely hazardous. Although the cholinesterase levels in farmers are in the normal range, they can increase over a long period of time. The length of farming is a predictor of cholesterol levels in farmers.

Tularemia From Veterinary Occupational Exposure.

Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia.

Preferences and Perceptions of Paediatric Dentists’ Attire among 4-12-year-old Children: A Cross-sectional Study

Introduction: Dentists’ attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient’s preferences and perceptions towards the dentist’s attire can aid in establishing a more efficient and smoother relationship between them. Aim: To determine the children’s preferences and perceptions of their paediatric dentist’s attire and PPE among four to 12- year-old children. Materials and Methods: This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/ guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist’s attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05. Results: A total of 362 participants with a mean age of 8.4±2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p<0.001) and younger participants (p<0.001). Both males and females (p=0.025) and older participants (p = 0.001) significantly favoured the traditional white coats over colourful paediatric coats. Furthermore, older participants significantly preferred surgical masks over paediatric masks (p<0.001), face shields as eye protection (p<0.001), and no head cover over colourful paediatric caps (p<0.001). Male participants showed significantly better acceptability towards the dentist wearing the full standard PPE. Conclusion: Both genders and younger children preferred female dentists. The traditional white coat is the most preferred attire by both genders and older children. Male and older children showed higher acceptability for the full standard PPE.

Identification of the normative use of medical protective equipment by fusion of object detection and keypoints detection

Background and ObjectiveIrregular use of personal protective equipment (PPE) seriously affects the occupational health and safety of healthcare workers, especially in large public health emergencies such as COVID-19. The danger often occurs in some complex scenarios where the use of certain equipment does not comply with the spatial rules it specifies. The single object detection-based method is difficult to effectively verify whether the worker's use of PPE is normative. Also detecting the use of six classes of PPE brings a large computational load to the task. MethodsIn this paper, we proposed an identification approach that combined human keypoints detection with deep learning object detection to help facilitate the monitoring of healthcare workers' standard PPE use. We used YOLOv4 as the baseline model for PPE detection and MobileNetv3 as the backbone of the detector to reduce the computational effort. In addition, High-Resolution Net (HRNet) was the benchmark for keypoints detection, characterizing the coordinates of 25 key points in the human body. Generalized Intersection over Union (GIoU) was used to establish the association between PPEs and key points, and by calculating the matching score between a PPE and the corresponding body bounding boxes, the authenticity of the PPE specification could be effectively inferred. ResultsThe proposed detector is able to identify whether a healthcare worker is normatively using multiple equipment with a higher precision (95.81 %), recall (96.38 %), and F1-score (96.09 %). Meanwhile, the number of parameters (2.87 M) and the size of the model (6.4 MB) are also more lightweight than other comparative detectors. ConclusionsOur approach is more reliable for reasoning about the normality of personal protection for healthcare workers in some complex scenarios than a single object detection-based approach. The developed identification framework provides a new automated monitoring solution for protection management in healthcare, and the modular design brings more flexible applications for different medical operation scenarios.

Training to Improve Spatial Hearing andSituation Awareness when Wearing Hearing Protection.

Hearing protection devices (HPDs) are standard personal protective equipment in military settings, but many service members may choose to not use HPDs because they impair spatial hearing and situation awareness. In an effort to reduce barriers to compliance by improving situation awareness while wearing HPDs, this study investigated whether brief training could counteract spatial hearing deficits when wearing HPDs. Participant's ability to correctly apply the HPDs across days was also examined. Young adults were randomly assigned to one of two groups: training or control (n = 25/group). Participants in each group performed a spatial hearing task while wearing HPDs and in an open ear condition without HPDs. Individual targets were battlefield sounds or white noise presented from a speaker array that surrounded the participant in the horizontal plane. After presentation of each target sound, the participant then controlled a white noise "auditory pointer," which they moved to the perceived location of the target. The two primary measures were the percent of trials with very large errors (> 45°), which were usually due to confusing front and back locations, and absolute localization, which is the difference between the pointer location and the true sound location. Both groups were tested on Days 1 (baseline) and 5 (post-test). On Days 2 to 4, the training group wore HPDs while receiving auditory and visual feedback after each trial. Across all participants on Day 1, wearing HPDs increased the frequency of very large errors by about 3× and impaired localization by about 40%, relative to the open ear condition. When comparing performance at baseline (Day 1) and post-training Day 5, the training group with HPDs had significant reductions in very large errors and improved absolute localization (P values < .001). The training group also had significant improvements from Days 1 to 5 in the open ear condition. When the control group wore HPDs, there were also significant improvements from Days 1 to 5 (fewer very large errors and better localization), with smaller effect sizes vs. the training group. Controls did not have significant improvement in the open ear condition, but had similar trends. Most participants consistently applied the HPDs, but a subset of ∼20% frequently failed to achieve the criterion attenuation of 15 dB (over 0.25-4.0 kHz) in both ears. These findings show that simple, relatively brief practice and training can substantially reduce HPD impairments on spatial hearing and situation awareness. The gains from training and practice can inform the development of relatively simple, brief methods to reduce HPD spatial hearing impairments, potentially leading to increased HPD compliance. Longitudinal data show that a subset of participants would not have received the full benefit of hearing protection because of improper application of the HPDs.

Manajemen Risiko Keselamatan dan Kesehatan Kerja pada Perawat Menggunakan Hazard Identification Risk Assessment And Risk Control

A nurse in providing nursing care cannot be separated from risks that can cause work accidents. Occupational accident is an unexpected event that is not expected when doing work. Based on work-related accident and disease recapitulation data at X Depok Hospital, it shows that during the 2018-2022 period there were 6 incidents of needle sticks and 2 incidents of nurses slipping. The purpose of this study is to determine OSH risk management using Hazard Identification Risk Assessment and Risk Control. This research is a qualitative research. Data collection methods used are observation and interviews. The informants in this study were divided into main informants, namely the 3 heads of rooms and supporting informants, namely the team leader. Based on the research results, it is known that there are 7 work activities that are identified as having potential hazards. The hazards identified were biological hazard, namely the possibility of contracting the patient's disease, ergonomic hazard, namely waist injury, low back pain, HNP and physical hazard, namely injured hands. The risk assessment identified 1 extreme risk work activity, 4 high risk work activities and 2 low risk work activities. Control efforts are carried out namely the existence of Standard Operating Procedures and Personal Protective Equipment.

Analysis of the Issue of Special Clothing in the Operation of Fire Protection Units

Aim: The paper is aimed at presenting selected problems of the impact of the incident environment on the body of a firefighter-rescuer who is protected with standard personal protective equipment (PPE). The article is an overview and presents the hazards associated with working in harsh environmental conditions, followed by the characteristics of firefighters’ PPE (in particular, special clothing) that play a key role in such conditions. Introduction: The safety of those involved in a fire incident is a very important issue – both in terms of proper management of human resources and the organization of activities in the situation of the incident and after it. The article presents content related to the impact of selected environments on firefighter-rescuers and the importance of firefighters’ “special clothing” during operations. The information on the influence of hot and cold microclimate environments and chemical activity as a consequence of processes occurring during a fire is presented. The issue of the operation of the complex environment of the tactical field and its impact on those involved in incidents was addressed. Methodology: The article is based on a review of selected literature on the addressed subject. Conclusions: During an incident involving not only operations during a fire, but also after the fire is extinguished, a firefighter-rescuer is simultaneously exposed to many factors. In addition to the stress that accompanies such activities, physical and chemical factors that occur side by side should also be considered, often broadening and intensifying the negative impact. The analysis should cover the fullest possible range of factors to which a person is subjected and allow him/her to be equipped with the appropriate protective tools, which are the firefighter’s PPE. The introduced innovations should be multidirectional and include minimizing the risk of high or low temperatures, inhalation poisoning, or skin contact with toxins. In doing so, it should be kept in mind that changes in the structure and properties of clothing must correspond to both the trends observed in the market, the economy and the dynamics of the course of fire. Therefore, it is necessary to work in parallel in many areas, taking into account the properties of the used materials, the spread and nature of incidents, and the tools at the disposal of the firefighter-rescuer. Keywords: hazard factors, firefighter’s personal protective equipment, firefighter’s special clothing, innovations

Selected Aspects of Transformation of Textile Elements of Firemen's Personal Protection

Aim: The purpose of the article is to present selected problems related to the directions of changes in the clothing that is the equipment of the rescuer firefighter and that is part of standard personal protective equipment. Introduction: Development in technology and the economy is resulting in products with increasingly complex structures in our environment. In the event of a fire, substances can be emitted that threaten the health and life of the firefighter. Therefore, personal protective equipment used by firefighters (including clothing) must be constantly adapted to the changing environment. Both the fibres and the structure or layering of the garment are modified. Increasingly, users of these products expect adequate resistance to biological and chemical agents. This is a result of the increasing number of factors that pose a risk when firefighters are working. Despite the clothing modifications used to date, it is still not possible to exclude the risk of toxic substanc- es, such as polyaromatic hydrocarbons, which are products of combustion in a fire environment, and acid gases penetrating the firefighter’s skin. The simultaneous exposure to radiant heat in the fire environment and the physical work performed by the firefighter significantly intensify the heat and mass exchange in the personal protection. Therefore, the interaction of protective structures with the rescuer’s body is playing an increasingly important role. Modifications based on nanotechnology are being used to make garments more resistant while maintaining or even reducing their weight. However, it should be pointed out that sometimes the changes concern one aspect, such as humidity, to the exclusion of other hazards arising from the physical and chemical characteristics of the substances emitted during the event. Methodology: The article is based on a review of selected literature on the topic covered. Conclusions: Modifications made to the fibres or to the structure and composition of the garment make it possible to obtain a product with improved performance in terms of protecting the firefighter. It is important to note, however, that they should consider all possible exposure pathways and not focus on one selected parameter. Therefore, further work is needed to adapt clothing to the emerging risks. Keywords: innovations, firefighter’s personal protective equipment, firefighter’s special clothing

Personal Protective Equipment (PPE) and Nurses’ Anxiety During the Covid-19 Pandemic

Anxiety felt by nurses is a vague fear accompanied by feelings of uncertainty, helplessness, isolation, and insecurity when performing nursing care during the Covid-19 pandemic. Nurses need personal protective equipment as a barrier against substance penetration, solid, liquid, or airborne particles to protect against injury or the spread of disease. The purpose of this study is to identify characteristics, length of work, PPE training, Psychologic services, PPE access, booster vaccination, standard PPE nurse anxiety and the correlation between PPE and anxiety on nurses in the COVID-19 room. This research is a quantitative study using a causal - comparative study design that is non-experimental (ex post facto). The sampling method used is purposive sampling technique approach with a sample of 90 respondents using data entry with demographic data sheet, PPE completeness checklist sheet to determine PPE completeness and to determine nursing anxiety using the Hamilton Anxiety Rating Scale questionnaire. Results showed the majority of nurses were middle-aged, woman, diploma, married, working more than 2 years, have participated in PPE training, not aware of access to psychological service, experienced easy accessibility of PPE, has not received a booster vaccine, using standardized PPE and experienced mild anxiety. This study shows that there is no significant difference in mean (p value&gt; 0.05), which means that PPE training, psychological services, access to PPE, booster vaccinations, standardized PPE did not correlate to nurses’ anxiety. The government is expected to give intervention through policies to address nurses’ anxiety and factors related to this, such as providing effective counselling services.

Silicone passive sampling used to identify novel dermal chemical exposures of firefighters and assess PPE innovations.

A plethora of chemicals are released into the air during combustion events, including a class of compounds called polycyclic aromatic hydrocarbons (PAHs). PAHs have been implicated in increased risk of cancer and cardiovascular disease, both of which are disease endpoints of concern in structural firefighters. Current commercially available personal protective equipment (PPE) typically worn by structural firefighters during fire responses have gaps in interfaces between the ensemble elements (e.g., hood and jacket) that allow for ingress of contaminants and dermal exposure. This pilot study aims to use silicone passive sampling to assess improvements in dermal protection afforded by a novel configuration of PPE, which incorporates a one-piece liner to eliminate gaps in two critical interfaces between pieces of gear. The study compared protection against parent and alkylated PAHs between the one-piece liner PPE and the standard configuration of PPE with traditional firefighting jacket and pants. Mannequins (n=16) dressed in the PPE ensembles were placed in a Fireground Exposure Simulator for 10min, and exposed to smoke from a combusting couch. Silicone passive samplers were placed underneath PPE at vulnerable locations near interfaces in standard PPE, and in the chamber air, to measure PAHs and calculate the dermal protection provided by both types of PPE. Silicone passive sampling methodology and analyses using gas chromatography with mass-spectrometry proved to be well-suited for this intervention study, allowing for the calculation and comparison of worker protection factors for 51 detected PAHs. Paired comparisons of the two PPE configurations found greater sum 2-3 ring PAH exposure underneath the standard PPE than the intervention PPE at the neck and chest, and at the chest for 4-7 ring PAHs (respective p-values: 0.00113, 0.0145, and 0.0196). Mean worker protection factors of the intervention PPE were also greater than the standard PPE for 98% of PAHs at the neck and chest. Notably, the intervention PPE showed more than 30 times the protection compared to the standard PPE against two highly carcinogenic PAHs, dibenzo[a,l]pyrene and benzo[c]fluorene. Nine of the detected PAHs in this study have not been previously reported in fireground exposure studies, and 26 other chemicals (not PAHs) were detected using a large chemical screening method on a subset of the silicone samplers. Silicone passive sampling appears to be an effective means for measuring dermal exposure reduction to fireground smoke, providing evidence in this study that reducing gaps in PPE interfaces could be further pursued as an intervention to reduce dermal exposure to PAHs, among other chemicals.

Simulation Method for Testing Aerosol Mitigation Strategies: An Observational Study.

Frontline health care workers who perform potentially aerosol-generating procedures, such as endotracheal intubations, in patients with coronavirus disease 2019 may be at an increased risk of exposure to severe acute respiratory syndrome coronavirus 2. To continue to care for patients with coronavirus disease 2019, minimizing exposure is paramount. Using simulation, we devised a testing method to evaluate devices that may mitigate the spread of aerosol and droplet-sized particles. In this prospective single-center study, participants intubated a manikin 3 times using standard personal protective equipment, once with no barrier device, once with an acrylic box, and once with a modified horizontal drape. The micrometer-sized particle count, generated by a nebulization model, was recorded before and after each intubation. The first-pass intubation rate and time to intubation were recorded. Each operator completed a postsimulation survey about their experience using the barrier devices. Thirty airway proceduralists completed the simulation and survey. There was no significant difference in particle counts (aerosols or droplets) or first-pass intubation, but the horizontal drape was found to significantly increase intubation time ( P = 0.01). Most participants preferred the drape over the acrylic box or no barrier device. The acrylic box and plastic drape did not mitigate particle spread. However, our testing method can be used to test barrier designs using negative pressure or other mitigation strategies for particle spread.

EDUKASI PENINGKATAN PENGETAHUAN DAN PERILAKU KESELAMATAN KESEHATAN KERJA NELAYAN TERHADAP ALAT PELINDUNG DIRI

Occupation, including fishermen, is one type of work that has potential hazards and risks of accidents and occupational diseases because fishing activities are carried out in the middle of the sea or along the coast. Fishermen can experience work accidents such as drowning, drifting, ship damage, injuries due to fish spines, low back pain, fever and others. Fishermen need personal protective equipment to reduce the risk of accidents and occupational diseases. The objectives of holding education to increase knowledge and behavior of fishermen's occupational health safety regarding personal protective equipment in fishermen settlements in Galang District, Batam City are: 1) increasing knowledge of occupational safety and health of fishermen regarding fishermen's personal protective equipment. 2) improve fishermen's occupational safety and health behavior towards personal protective equipment. 3) fishermen can use standard personal protective equipment.

Peningkatan Pengetahuan Buruh Tani Akan Bahaya Pestisida dan Penggunaan Alat Pelindung Diri Yang Benar Melalui Penyuluhan

Farm labor is one of the main livelihoods in Indonesia. Farmers' activities on agricultural land are never separated from the use of pesticides, although basically pesticides are not only harmful to plant pests but also pose a potential hazard to farm workers as pesticide users. Various types of pesticides circulating and used in Indonesia include the type of organophosphate. Jam because of its affordable price, organophosphates have good effectiveness in controlling plant pests. This ability is comparable to the dangers of organophosphates for health. Various studies have proven that organophosphate pesticides and other pesticides can cause both acute and chronic health problems. Health problems can range from mild to severe symptoms resulting in disability or death. Pesticides intoxication can actually be prevented. One of the prevention efforts that can be done is the use of good and correct Personal Protective Equipment (PPE). Farmers actually know about the potential dangers of pesticides and the importance of using PPE when spraying pesticides. However, most farm workers do not use standard PPE and do not know how to use the correct PPE. They choose to use simple PPE that they make themselves, for example using t-shirts as head coverings and face masks instead of using hats, goggles and masks as face and head protection. These measures are, of course, non-standard and cannot provide perfect protection. The community service that is carried out has the target of farm workers who live in Gayasan Village, Jenggawah District, Jember Regency. This community service activity uses counseling methods and training on the proper and correct use of PPE, accompanied by the implementation of free health checks and medication for farm laborers and the surrounding community. Measurement of the level of knowledge is measured using a questionnaire and then compared between before and after counseling. The results obtained are an increase in the knowledge of farm workers about the dangers of pesticides and the use of good and standard PPE.

Development of an emergency airway response system for COVID-19 at a tertiary care hospital in resource limited country.

The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare due to highly transmissible and contagious nature. Aerosol generating procedures such as tracheal intubation is of particularly high risk. This mandates some advice on processes and techniques required to protect staff and uniform approach during airway management. We hereby share our experience in development of an emergency response system to deal with COVID airway management at a frontline hospital which particularly consider the local demands and resources. This includes a change in working dynamics with 24/7 consultant coverage for emergent or urgent tracheal intubation of COVID patients at non-operating room locations. Other steps include prepackaging intubation baskets, availability of videolaryngoscope, standard personal protective equipment including powered air purifying respirator, and use of modified intubation checklist.

"I don't mean to be rude, but could you put a mask on while I'm here?" A qualitative study of risks experienced by domiciliary care workers in Wales during the COVID-19 pandemic.

Domiciliary care workers (DCWs) continued to provide care to adults in their own homes throughout the COVID-19 pandemic. The evidence of the impact of COVID-19 on health outcomes of DCWs is currently mixed. The OSCAR study will quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, explore causes of variation and extrapolate to the rest of the UK DCW population. An embedded qualitative study aimed to explore DCW experiences during the pandemic, including factors that may have varied risk of exposure to COVID-19 and adverse health and wellbeing outcomes. Registered DCWs working throughout Wales were invited to participate in a semi-structured telephone interview. 24 DCWs were interviewed between February and July 2021. Themes were identified through inductive analysis using thematic coding. Several themes emerged relating to risk of exposure to COVID-19. First, general changes to the role of the DCW during the pandemic were identified. Second, practical challenges for DCWs in the workplace were reported, including staff shortages, clients and families not following safety procedures, initial shortages of personal protective equipment (PPE), DCW criticism of standard use PPE, client difficulty with PPE and management of rapid antigen testing. Third, lack of government/employer preparation for a pandemic was described, including the reorganisation of staff clients and services, inadequate or confusing information for many DCWs, COVID-19 training and the need for improved practical instruction and limited official standard risk assessments for DCWs. Pressure to attend work and perceptions of COVID-19 risk and vaccination was also reported. In summary, this paper describes the risk factors associated with working during the pandemic. We have mapped recommendations for each problem using these qualitative findings including tailored training and better support for isolated team members and identified the required changes at several socio-ecological levels.

FACTORS THOSE ARE RELATED TO THE INCIDENCE OF NEEDLE STICKS ON INPATIENT NURSES AT DR. SITANALA KOTA TANGERANG HOSPITAL

Avoiding needles for a hospital nurse is very important because even the most minor treatment can pose a risk to the nurse. Use of personal protective equipment, age, years of service, knowledge of occupational health and safety, and training are related to needle sticking for hospital nurses. This research aims to analyze the relationship between the use of personal protective equipment, age, years of service, knowledge, and training with the incidence of needle sticking to nurses in hospitals. This type of research is observational with a cross-sectional study approach. The sample in this study was 47 people. Primary data collection using a questionnaire. Data analysis uses univariate statistics to describe the characteristics of respondents, and bivariate statistics use the Chi-Square test to analyze the relationship between variables. The study shows that there is a significant relationship between the use of Personal Protective Equipment, knowledge and training with the needle sticking in nurses at Dr. Sitanala Kota Tangerang Hospital, with the results of the analysis of Personal Protective Equipment (p = 0.043), knowledge (p = 0.035) and training (p = 0.024). There is no significant relationship between age and years of service with the needle sticking in nurses at Dr. Sitanala Kota Tangerang Hospital, with the analysis of age (p = 0.183) and years of service (p = 0.103). From the results of this study, it was suggested that it was necessary to increase knowledge and training for nurses and improve compliance in preventing needle sticks, both "out of a job" and "on the job" training at least every six months. In addition, it is recommended to carry out regular socialization through leaflets or banners posted in every room about the importance of using good and standard Personal Protective Equipment (PPE) in their duties.

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.

Description of the Knowledge, Attitudes, and Behavior of the Community Behavior about Toward Coronavirus Disease Self-isolation in the Working Area of Pauh Health Care in 2021

BACKGROUND: Coronavirus disease-19 (COVID-19) was a disease caused by SARS-CoV-2. The positivity rate for COVID-19 at the Pauh Health Center until August 2021 reached 34.95%. AIM: The aim of this research to find out about knowledge, attitudes, and behavior the community behavior toward coronavirus disease (COVID-19) self-isolation in the working area of Pauh Health Care. METHODS: This study used a political and logical approach with descriptive and cross-sectional design. The research was conducted from August to September 2021 in Cupak Tangah, South Limau Manis, and Koto Luar. The research data were obtained by filling out the respondent’s questionnaire and guided interview. RESULTS: The problem found using the Hanlon method was the high positivity rate of COVID-19 at the Pauh Health Center. This was due to several factors, such as the lack of public knowledge about COVID-19 and self-isolation, lack of awareness in implementing health protocols, lack of concern and negative stigma toward people who are confirmed to have COVID-19, lack of strict supervision of health protocols by cross-sectors, and obstacles in purchasing Standard Personal Protective Equipment (PPE). CONCLUSION: The solution to the high COVID-19 positivity rate in the Pauh Health Center work area was to form an independent isolation module using the Plan, Do, Check, and Action (PDCA) flow, making this module can be an outcome in helping to improve people’s behavior and educating the public to behave well according to the rules.

Effect of enhanced personal protective equipment on colonoscopy performance and pain linked to procedure during the COVID-19 pandemic.

During the COVID-19 pandemic, the use of standard personal protective equipment (SPPE) reduces transmission risks during endoscopic procedures. Our aim was to assess the effect of enhanced personal protective equipment (EPPE) on colonoscopy performance and pain linked to the procedure compared with SPPE. During two similar periods with three-month duration (in 2019 and in 2020 during the COVID-19 pandemic), electronic medical records and colonoscopy reports were investigated for sequential patients undergoing colonoscopy. SPPE was used in 2019 and EPPE in 2020. The patients' clinical data and information related to the procedure were collected and analyzed. Primary outcomes were the duration to intubate the cecum, total procedure duration and patient pain score at the end of the procedure. Secondary outcomes were adenoma detection rate (ADR), polyp detection rate (PDR) and cecal intubation rate (CIR). A total of 426 patients with colonoscopy performed were analyzed. The demographic features and indications for colonoscopy were similar for patients in both groups. The EPPE group had higher values for the parameters assessed as primary endpoints of cecal intubation time, withdrawal time, total procedure time and pain at the end of the procedure compared to the SPPE group and the differences were statistically significant. Conclusion: Our findings show that though the use of EPPE negatively affected colonoscopy performance and patient pain at the end of the procedure, it had no effect on the colonoscopy quality indices such as ADR, PDR and CIR.

Is Face Mask with Face Shield More Effective than Face Mask Alone in Reducing SARS-CoV-2 Transmission? A Systematic Review

Background. The use of face shield in addition to face mask is thought to reduce the transmission of SARS-CoV-2 by blocking respiratory droplets and by preventing one from touching facial orifices.&#x0D; Objective. To determine the effectiveness of face mask with face shield, compared to face mask alone, in reducing transmission of SARS-CoV-2.&#x0D; Methods. We searched MEDLINE, Cochrane Library, as well as trial registers, preprint sites and COVID-19 living evidence sites as of 30 September 2021. We included studies that used face shield with face mask versus face mask alone to prevent COVID-19. We screened studies, extracted data, assessed the risk of bias and certainty of evidence using the GRADE approach. Review Manager 5.4 was used to estimate pooled effects.&#x0D; Results. There is no available direct evidence for face shield plus face mask versus face mask alone in the general public. Five (5) observational studies with very low certainty of evidence due to serious risk of bias and indirectness were included. Participants in all the studies were health care workers (HCWs) who used the face shield with their standard personal protective equipment (PPE). Four (4) of the studies were in the hospital setting (three case control studies, one pre- and post-surveillance study); one was done in the community (one pre- and post-surveillance study) in which HCWs visited the residence of the contacts of SARS-CoV-2 positive patients. The case control studies done in the hospital setting showed a trend toward benefit with the use of face shield or goggle but this was inconclusive (OR 0.85, 95% CI 0.68-1.08) while the pre- and post-surveillance study showed significant benefit when face shield (OR 0.28, 95% CI 0.22-0.37) use became a requirement for HCWs upon hospital entry. In the study done in the community setting, significant protection for HCWs was noted with the use of face shield (OR 0.04, 95% CI 0.00-0.69) but the results were limited by serious risk of bias and imprecision.&#x0D; Conclusion. In the hospital setting, there was a lower likelihood of COVID-19 infection in HCWs who used a face shield or goggles on top of their PPE. For the general public in the community, there is presently no study on the use of face shield in addition to the face mask to prevent COVID-19 infection.