Response to COVID-19 by the surgical community

In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or Severe Acute Respiratory Syndrome (SARS), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCW use PPE as instructed.

"Test and Standard Precautions"-Is It Enough to Protect Us From False-Negative Severe Acute Respiratory Syndrome Coronavirus 2 Test Results?

Ancillary protective gears in the COVID- 19 Era.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

BackgroundAs evidence rapidly changes, a need for consensus in hospital policy and management aspects of COVID-19 patient care are needed. This study describes areas where consensus exists and is needed in infection control, and occupational health policy.MethodsAn online survey was sent to the membership of the Association of Medical Microbiology and Infectious Disease (n~700). The survey included questions about COVID-19 patient and outbreak management, personal protective equipment (PPE), and occupational health considerations.ResultsOur preliminary results (n=24) were from infectious disease MD/NP or infection control medical directors. All respondents agreed treatment of COVID-19 patients should only occur in the context of a clinical trial. Of 18 centers with neonatal populations, the majority (64.2%) did not have any neonatal specific treatment guidelines. Well-babies born to COVID-19 positive moms, are all being tested (10 of 10 respondents). Variation in practice on when to remove a patient from additional precautions and potential aerosol generating medical procedures (Table 1, 2). Universal masking is in place for all clinical staff (100%), non-clinical staff (70.8%), essential visitors or patient caregivers (70.8%), and universal eye protection is in place for clinical staff (93.3%), but there was a lack of consensus in PPE conservation strategies (Table 3). Most staff do not use neck PPE (68.2%), however there was comments of it being requested by anesthesiologists at 2 sites (Table 2). Healthcare trainees or workers in these groups were restricted from caring for COVID-19 patients; Age >65 years (54.5%) and immunocompromised status (54.5%). COVID-19 positive staff can return to work 14 days after symptom onset (84.2%).Table 1. Areas of COVID-19 management lacking consensus. Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator.Table 2. Procedures considered as aerosol generating medical procedures (AGMPs). Respondents (n=24) were allowed to select more than one option.Table 3. Personal protective equipment (PPE) conservation strategies (n=24). Not all respondents answered every question. The percentage in brackets was calculated with the number of respondents per question as the denominator. NA corresponds to the question not asked in the survey.ConclusionAcross Canada, while there are areas of consensus in outbreak definitions, universal masking of clinical staff. There is significant variation in practice with respect to discontinuing additional precautions or outbreak measures, asymptomatic testing, AGMP definitions, PPE conservation strategies including reprocessing. As evidence evolves, national infection control guidelines will be important to improve standardization of practice and optimize patient care and staff safety.DisclosuresAll Authors: No reported disclosures

AimThe rapid spread of the COVID‐19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed.MethodThis manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment.ResultsDuring the COVID‐19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID‐19 testing and the incidence of known COVID‐19 infection in the respective community. In addition to standard COVID‐19 PPE precautions, a negative‐pressure environment, including an OR, has been recommended, especially for the performance of aerosol‐generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive‐pressure to negative‐pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS‐CoV‐2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management.ConclusionThis paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID‐19 pandemic.

A pesticide exposure algorithm was developed to calculate pesticide exposure intensity scores based on responses to questions about pesticide handling procedures and application methods in a self-administered questionnaire. The validity of the algorithm was evaluated through comparison of the algorithm scores with biological monitoring data from a study of 126 pesticide applicators who applied the herbicdes MCPA or 2,4-D. The variability in the algorithm scores calculated for these applicators was due primarily to differences in their use of personal protective equipment (PPE). Rubber gloves were worn by 75% of applicators when mixing and 22% when applying pesticides, rubber boots were worn by 33% when mixing and 23% when applying, and goggles were worn by 33% and 17% of applicators when mixing and when applying, respectively. Only 2% of applicators wore all three types of PPE when both mixing and applying, and 15% wore none of these three types of PPE when either mixing or applying. Substantial variability was also observed in the concentrations of pesticides detected in the post application urine samples. The concentration of MCPA detected in urine samples collected on the second day after the application ranged from less than < 1.0 to 610 μg/L among 84 of the applicators who applied MCPA. The concentrations of 2,4-D detected in the urine samples ranged from less than < 1.0 to 514 μg/L among 41 of the applicators who applied 2,4-D. When categorized into three groups based on the algorithm scores, the geometric mean in the highest exposure group was 20 μg/L compared with 5 μg/L in the lowest exposure group for the MCPA applicators, and 29 μg/L in highest exposure group compared with 2 μg/L in the low exposure group for the 2,4-D applicators. A regression analysis detected statistically significant trends in the geometric mean of the urine concentrations across the exposure categories for both the 2,4-D and the MCPA applicators. The algorithm scores, based primarily on the use of PPE, appear to provide a reasonably valid measure of exposure intensity for these applicators, however, further studies are needed to generalize these results to other types of pesticides and application methods.

The first activity carried out in this service activity was observation to determine problems in activities at PT Bali Moda Busana. Observations are only focused on the production department and some management staff. Based on the observations that have been made, it is found that the working environment at PT Bali Moda Busana, has the potential for physical hazards and the workers have not Personal Protective Equipment (PPE) at work which allows work accidents. The expected results in service activities are that employees in the production department have more knowledge about Occupational Safety and Health (K3); acquire knowledge of identifying potential hazards in the workplace and preventive measures for work accidents; and gain knowledge about the types of PPE (Personal Protective Equipment). Based on the results of this service activity in the form of counseling, training and mentoring that has been carried out; employees of the production department, to acquire knowledge about Occupational Safety and Health (K3); acquire knowledge of identifying potential hazards in the workplace and preventive measures for work accidents; and gain knowledge about the types of PPE (Personal Protective Equipment), then implement it in daily work, as the motto of work “Savety 1st”

Individuals most at risk of infection are those who are in close contact with COVID 19 patients, such as midwives who run Independent Practices. Midwives can protect themselves when providing care by complying with infection prevention and control practices that include proper administrative, environmental and engineering control and use of Personal Protective Equipment (PPE) (i.e. appropriate in the selection of the appropriate type of PPE, how it is used, how to release and how to dispose or wash PPE). So researchers are interested in researching the factors that affect the behavior of the use of PPE in health workers. This study aimed to analyze factors that can affect the behavior of PPE use among midwives. This type of research was observational analytical research methods. The population in this study was 87 midwives. The study was conducted in Sambas Regency in July-August 2021. This research instrument was a questionnaire. The results of the study showed there was relationship between knowledge (p-value 0.395), and education level (p-value 0.103) with compliance, there was a relationship of working life (p-value 0.000) and availability of PPE (p-value 0.001) With Compliance of Using Personal Protective Equipment (PPE) in Sambas Regency In 2021. It is expected to be the basis and guideline to conduct further research related to the behavior of using PPE while working on midwives in health care facilities in Indonesia.

It is mandatory that healthcare workers wear personal protective equipment (PPE) while caring for COVID-19 patients. Studies have shown that wearing PPE for a prolonged time may lead to symptoms of physical discomfort including headache. The aim of this study is to assess the prevalence and association between prolonged use of PPE and headaches. This was a cross-sectional study. A convenience sample of healthcare workers who worked with COVID-19 patients in clinical settings was recruited. The data were collected through an electronic survey shared as a link through social media. This study included 1060 participants, 753 (71%) female and 307 (29%) male. Participants were divided into two groups. Group A had 628 (60%) participants who did not have chronic headache before the COVID-19 pandemic, while Group B contained 432 (40%) participants who had a previous chronic headache. Headaches differed significantly between Groups A and B in frequency, type, location, and quality during the COVID-19 period. The analysis found a significant relationship between duration of PPE use and headache occurrence. The significant relationship between the duration of PPE usage and headache occurrence among healthcare workers should be considered when refining policies and procedures regarding prolonged PPE use.

Healthcare Workers (HCWs) and public health professionals are playing a pivotal role in containing COVID-19. Personal Protective Equipment (PPEs) are a critical component in the hierarchy of primary infection controls to ‘break the chain of infection’ to protect patients, HCW’s, and public. As SARS-CoV-2 is highly contagious, and vaccine and prophylactics not yet available, understanding correct PPE usage is imperative. This study aims to: understand purpose, use, and quality standards of body-coveralls and gowns and how to use PPE’s for effective protection in COVID 19 in India. Types of PPE’s in healthcare, their purposes, materials used, and properties were reviewed. Gowns and Body-coveralls classification and standards in Europe, USA and India were studied. While current stipulated test standards for coveralls in India are lower, as routine use of reusable gowns made of woven fabrics is more common in India, one could hypothesize that these coveralls provide a higher level of protection. As per current understanding of mode(s) of transmission of SARS-CoV-2 a properly fitted N95 respirator; goggles and splash resistant face shield; gloves; and single-use full body-coverall/gown preferably resistant to Synthetic Blood Penetration under pressure and made of non-woven Laminated SMS (Spunbond-Meltblown-Spunbond)_or Non Laminated SSMMS fabrics are advisable depending upon anticipated level of exposure. HCW’s should educated about transmission risks, correct principles of infection control, functional purpose of PPE’s and must be conscious that PPE’s alone will not protect them. They must follow good practices of how to wear (don) and how to remove (doff) and ensure that they do not inadvertently contaminate their clothing/skin and self-inoculate.

The Crucible of War: Innovation in a Pandemic.

Occurrence of personal protective equipment (PPE) associated with the COVID-19 pandemic along the coast of Lima, Peru

Maintenance of a safe and stable health care infrastructure is critical to an effective mass casualty disaster response. Both secondary contamination during chemical disasters and hospital-associated infections during epidemic illness can pose substantial threats to achieving this goal. Understanding basic principles of decontamination and infection control during responses to chemical and biologic disasters can help minimize the risks to patients and health care workers. Effective decontamination following toxic chemical exposure should include both removal of contaminated clothing and decontamination of the victim's skin. Wet decontamination is the most feasible strategy in a mass casualty situation and should be performed promptly by trained personnel. In the event of an epidemic, infection prevention and control measures are based on essential principles of hand hygiene and standard precautions. Expanded precautions should be instituted as needed to target contact, droplet, and airborne routes of infectious disease transmission. Specific equipment and measures for critical care delivery may serve to decrease risk to health care workers in the event of an epidemic. Their use should be considered in developing comprehensive disaster response plans.

Introduction: In 2020 as much as 89,3% from 180 COVID-19 patients have a comorbidity. Patients with comorbidity are more at risk of being infected with COVID-19 with severe clinical manifestations. This challenge requires nurses to be more critical in treating of COVID-19 patients with comorbidity to prevent complications and mortality. This study aimed to explore the nurse’s experiences in caring for COVID-19 patients with comorbidity in private hospital in central of Jakarta.&#x0D; Methods: The researcher applied a phenomenological descriptive design. Data were collected using in-depth interview from 12 nurses. The participants were nurses who work in COVID-19 unit and have treated patient COVID-19 with comorbidity obtain purposive sampling. The research conducted from November 2020 to February 2021 and data were analyzed by Colaizzi’s method.&#x0D; Result: The study found five key themes from nurse’s experience in caring for COVID-19 patients with comorbidity that includes fear in caring for COVID-19 patients, being very exhausted, high workloads, getting lesson learn from patients and God who strengthens us. Nurses express fear when caring for COVID-19 patients because of the fast and easy transmission of COVID-19 through droplets. Nurses also feel exhausted because they have to use layered PPE while working. The theme of high workload was revealed because of the influenced on the number of nurses due to the large number of those who contracted COVID-19 while working. The source of strength theme describes nurses as being greatly strengthened by their closeness to God.&#x0D; Conclusion: This study explores five key themes derived from the expressions of nurses who have experience treating COVID-19 patients with comorbidities. The recommendation from the result of this study suggests that the need for personal support such as motivation and psychology support from family and coworkers so that nurses feel more confident at work. Hospitals are also expected to make approach and provide psychological support for nurses who feel mental stres such as fear or exhausted after caring for COVID-19 patients.