Browsing by Subject "personal protective equipment"

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    Medical Student Concerns for Respiratory Protection on Anesthesiology Elective
    (2022-04-28) Yu, Corinna; Webb, Timothy; Guillaud, Daniel; Mitchell, Sally
    Introduction: Anesthesiologists perform aerosolizing procedures including endotracheal intubation, necessitating the use of personal protective equipment (PPE) such as N95 masks during the Coronavirus Pandemic. Medical students rotating on anesthesiology electives are similarly exposed to potential viral transmission during these procedures. Objective: This study compares student responses to concerns about their respiratory protection in 2020 vs. 2021. Methods: Medical students rotating on the Adult Anesthesia Elective (2020) and the Anesthesiology & Perioperative Medicine Elective (2021) were assigned to read, “Respiratory Protection for Healthcare Workers” and answer “Do you have any concerns about your respiratory protection?” 61 students completed the assignment in 2020, and 74 students in 2021. These responses were analyzed and coded for themes. 10 themes emerged for students who were concerned with their respiratory protection, and 4 themes emerged for students who were not concerned. Basic percentages were calculated and the number of students expressing various themes in their responses was summed and compared between 2020 vs. 2021. Results: In 2020, 35% of students were concerned about their respiratory protection, decreasing to 28% in 2021. Reasons for students not being concerned include the availability of PPE, vaccination status, testing patients for COVID pre-operatively, and the option to avoid the risk. Reasons for concern included the aerosol-generating nature of intubation, N95 masks should be single use, patients not being tested for COVID properly and failed fit tests and mask seals (only in 2020), availability of PPE, fear of being a vector, and not doffing properly. Long-term COVID complications and ability to socially distance at work were also concerns in 2020. Conclusion: Student concern with respiratory protection decreased from 35% to 28% from 2020 to 2021. One of the primary differences is that students were vaccinated in 2021. Students not concerned displayed confidence in PPE availability and patients testing negative for COVID-19 prior to OR procedures. In addition, some students commented on their ability to avoid risk by not caring for COVID-positive patients, although one student commented this hindered their education. Student concerns included viral transmission during aerosolizing procedures and the observation of N95 mask reuse, which is not advised. Some students were not able to get a fit test due to PPE shortages or had failed their fit test in 2020. Facial hair and having a beard was a concern in both 2020 and 2021 for proper mask fit. Other students feared being an asymptomatic carrier and acting as a vector to their patients and loved ones. Similarly, they worried that the testing window for patients was too wide. Students in both 2020 and 2021 expressed concern about self-contamination from not doffing their PPE properly. A few students commented on the unknown long-term effects of COVID-19 and the inability to socially distance at work. Generally, students were not concerned with PPE availability and their personal safety in the clinical environment on their anesthesiology elective. As the pandemic continues to evolve, time will tell if we can continue to maintain PPE supplies, effective vaccines, and work to decrease student concerns.
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    Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self‐Contamination During Donning and Doffing
    (Elsevier, 2022-03) Doos, Devin; Barach, Paul; Sarmiento, Elisa; Ahmed, Rami; Emergency Medicine, School of Medicine
    Background At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. Objective The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. Methods The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. Results All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. Conclusions The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.
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    Safety practices for in-office laryngology procedures during clinical reintroduction amidst COVID-19
    (Wiley, 2021-08) Calcagno, Haley; Anthony, Benjamin P.; Halum, Stacey L.; Parker, Noah P.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective Describe safety practices for performing in-office laryngology procedures during clinical re-introduction amidst the coronavirus disease 2019 (COVID-19) pandemic. Methods An anonymous survey in Qualtrics was created to evaluate demographics, preprocedure testing, practice settings, anesthesia, and personal protective equipment (PPE) use for five procedure categories (non-mucosal-traversing injections, mucosal-traversing injections, endoscopy without suction, endoscopy with suction/mucosal intervention via working channel, and laser via working channel). The survey was emailed to the Fall Voice Community on Doc Matter and to members of the American Broncho-Esophagological Association (ABEA) from May to June 2020. Results Eighty-two respondents were analyzed (response rate: 10%). Respondents represented diverse locations, including international. Most reported academic (71%) or private practices (16%), laryngology fellowship training (76%), and a significant practice devotion to laryngology and broncho-esophagology. During the early re-introduction, most continued to perform all procedure categories. The office was preferred to the OR setting for most, though 36% preferred the OR for laser procedures. There was a preference for preprocedural SARS-Cov2 testing for procedures involving a working channel (>67%), and these procedures had the highest proportion of respondents discontinuing the procedure due to COVID-19. Various types of topical anesthesia were reported, including nebulizer treatments. The most common forms of personal protective equipment utilized were gloves (>95%) and N95 masks (>67%). Powered-air purifying respirators and general surgical masks were used infrequently. Conclusions During the early re-introduction, respondents reported generally continuing to perform office laryngology procedures, while greater mucosal manipulation affected decisions to stop procedures due to COVID-19, perform preprocedural SARS-Cov2 testing, and alter topical anesthesia. Gloves and N95 masks were the predominate PPE. Level of Evidence N/A.