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Risk of self-contamination during doffing of personal protective equipment
Background: The aim of this study was to describe the risk of self-contamination associated with doffing of personal protective equipment (PPE) and to compare self-contamination with various PPE protocols. Methods: We tested 10 different PPE donning and doffing protocols, recommended by various health organizations for Ebola. Ten participants were recruited for this study and randomly assigned to use 3 different PPE protocols. After donning of PPE, fluorescent lotion and spray were applied on the external surface of the PPE to simulate contamination, and ultraviolet light was used to count fluorescent...
Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals
A Qualitative Study Importance: Using personal protective equipment (PPE) and transmission-based precautions are primary strategies for reducing the transmission of infectious agents. Objective: To identify and characterize failures in transmission-based precautions, including PPE use, by health care personnel that could result in self-contamination or transmission during routine, everyday hospital care. Design, Setting, and Participants: This qualitative study involved direct observation inside and outside patient rooms on clinical units from March 1, 2016, to November 30, 2016. Observations occurred...
NFPA 1999 - Standard on Protective Clothing and Ensembles for Emergency Medical Operations
This standard specifies requirements for EMS protective clothing to protect personnel performing patient care during emergency medical operations from contact with blood and body fluid-borne pathogens. It also includes additional requirements that provide limited protection from specified CBRN terrorism agents. Source: https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1999
Chemical, Biological, Radiological, and Nuclear (CBRN) Respiratory Protection Handbook
Since 2001, the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) has established performance and design standards for respiratory protective devices (RPDs) to protect against chemical, biological, radiological, and nuclear (CBRN) hazards and toxic industrial chemicals. Prior to 2001, there were no standards for the use of RPDs by U.S. emergency response personnel that covered the full range of expected CBRN threats. Federal regulations require emergency response personnel to use respirators...
Modified gloves: A chance for the prevention of nosocomial infections
Background: Non-sterile gloves primarily serve as a barrier protection for health care workers (HCWs). However, pathogens may often contaminate the skin of HCWs during glove removal; therefore, pathogens may be further transmitted and cause nosocomial infections. Methods: A field study was conducted comparing contamination rates when using standard gloves or a new modified product equipped with an additional flap (doffing aid) for easier removal. Gloves were removed after bathing gloved hands in an artificial fluorescent lotion. The number of contamination spots was then visually examined using...
ASTM F2100 - 11(2018) - Standard Specification for Performance of Materials Used in Medical Face Masks
This specification covers the classifications, performance requirements, and test methods for the materials used in the construction of medical face masks that are used in health care services such as surgery and patient care. Medical face mask material performance is based on testing for bacterial filtration efficiency, differential pressure, sub-micron particulate filtration efficiency, resistance to penetration by synthetic blood, and flammability. This specification does not address all aspects of medical face mask design and performance, the effectiveness of medical face mask designs as related...
Glove: Use for safety or overuse?
Occupational exposure to blood and body fluids presents a major safety risk for bloodborne viruses to all health care workers (HCWs). In response to human immunodeficiency syndrome (HIV), various strategies were adopted to reduce this risk. The most important and cost-effective strategy was the introduction of gloves as part of personal protective equipment (PPE) for all potential or expected exposures to blood and body fluid. The term gloves in this report refer to nonsterile, medical, and examination gloves. Source: Jain, S., Clezy, K., & McLaws, M. L. (2017). American Journal of Infection...
Modified gloves: A chance for the prevention of nosocomial infections
Background: Non-sterile gloves primarily serve as a barrier protection for health care workers (HCWs). However, pathogens may often contaminate the skin of HCWs during glove removal; therefore, pathogens may be further transmitted and cause nosocomial infections. Methods: A field study was conducted comparing contamination rates when using standard gloves or a new modified product equipped with an additional flap (doffing aid) for easier removal. Gloves were removed after bathing gloved hands in an artificial fluorescent lotion. The number of contamination spots was then visually examined using...
Evaluation of surgical glove integrity and factors associated with glove defect
Background: Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. Material and methods: This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons...
Reliability of N95 respirators for respiratory protection before, during, and after nursing procedures
Background: The adequate fit of an N95 respirator is important for health care workers to reduce the transmission of airborne infectious diseases in the clinical setting. This study aimed to evaluate whether adequately sealed N95 respirators may provide consistent protection for the wearer while performing nursing procedures. Methods: Participants were a group of nursing students (N = 120). The best fitting respirator for these participants was identified from the 3 common models, 1860, 1860S, and 1870+ (3M), using the quantitative fit test (QNFT) method. Participants performed nursing...
Évaluation d’une politique obligatoire de vaccination contre l’influenza ou de port d’un masque pour les travailleurs de la santé
L'objectif d'une telle politique est de réduire le fardeau de l'influenza transmis par les travailleurs non vaccinés aux patients et de prévenir les éclosions dans les milieux de soins. Les prémisses sous-jacentes à cette politique sont que ce fardeau est important et que la vaccination des travailleurs contre l'influenza ou le port du masque le réduira substantiellement. Il est difficile d'obtenir, sur une base volontaire, des couvertures vaccinales de plus de 70 % chez les travailleurs des hôpitaux de soins aigus, alors...
Comparison of two quantitative fit-test methods using N95 filtering facepiece respirators
Current regulations require annual fit testing before an employee can wear a respirator during work activities. The goal of this research is to determine whether respirator fit measured with two TSI Portacount instruments simultaneously sampling ambient particle concentrations inside and outside of the respirator facepiece is similar to fit measured during an ambient aerosol condensation nuclei counter quantitative fit test. Sixteen subjects (ten female; six male) were recruited for a range of facial sizes. Each subject donned an N95 filtering facepiece respirator, completed two fit tests in random...
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or 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 HCWs use PPE as instructed. To evaluate which type or component of full-body PPE and which method of donning or removing (doffing) PPE have the least risk of self...
Face shields for infection control: A review
Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment. Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available...
Ebola Care and Lack of Consensus on Personal Protective Respiratory Equipment
The Ebola epidemic in West Africa presents a considerable occupational risk to the health personnel involved. The principal mode of virus transmission to health care personnel is through direct contact with the patient, although transmission by aerosols through the air may also occur. Many safety protocols have been suggested relating to personal protection and particularly respiratory protection. It is generally agreed that all health care workers should have easy access to personal protective equipment. However, the degree of respiratory safety escalates from a mask, to an adequate respirator...
Contamination of Health Care Personnel During Removal of Personal Protective Equipment
Importance: Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection. Objectives: To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination. Design, Setting, and Participants: We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November...
Baseline evaluation with a sweating thermal manikin of personal protective ensembles recommended for use in West Africa
OBJECTIVE: Experience with the use of personal protective equipment (PPE) ensembles by health care workers responding to the Ebola outbreak in the hot, humid conditions of West Africa has prompted reports of significant issues with heat stress that has resulted in shortened work periods. METHODS: A sweating thermal manikin was used to ascertain the time to achievement of a critical core temperature of 39°C while wearing 4 different PPE ensembles similar to those recommended by the World Health Organization and Médecins Sans Frontières (Doctors Without Borders) at 2 different ambient...
Disinfection of personal protective equipment for management of Ebola patients
Bessesen et al highlight the potential utility of reusable elastomeric face masks to bypass the risk of N95 respirator shortages during a respiratory illness pandemic and stress the importance of efficacious disinfection to reuse facial protective equipment safely.1 We would like to take the opportunity to underline the need that awareness on personal protective equipment (PPE) stocks is included in any pandemic preparedness plan. The demand for PPE must be established on the basis of the health care facility's role, defined by public health authorities to create a coordinated network approach...
Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions
Is less more? Background: Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use. Methods: We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance. Results: We assessed 426 HH indications before and 492 indications after the policy change...
Variation in health care worker removal of personal protective equipment
In the current era of emerging pathogens such as Ebola virus, removal of personal protective equipment (PPE) is crucial to reduce contamination of health care workers. However, current removal practices are not well described. We undertook a systematic evaluation of health care worker removal of PPE for contact isolation to examine variation in removal procedures. Findings indicate that under usual conditions, only about half of health care workers correctly remove their PPE, and very few remove their PPE in the correct order and dispose of it in the proper location. Source: Zellmer, Caroline,...
NIOSH, OSHA Release New Toolkit to Better Protect Hospital Workers from Transmissible Diseases
The National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) today released the Hospital Respiratory Protection Toolkit, a resource for health care employers to use to protect hospital staff from respiratory hazards. Respirators are used to protect against exposures to airborne transmissible infectious diseases as well as chemicals and certain drugs that may be used in healthcare settings. OSHA’s Respiratory Protection Standard requires that health care employers establish and maintain a respiratory protection program in workplaces...
Maladie à virus Ebola
Tenues et procédures de déshabillage des soignants en établissement de santé de référence Ce document a été conçu en collaboration avec la Société de Pathologie Infectieuse de Langue Française (SPILF), à partir du recueil et de la synthèse des procédures des établissements de santé de référence (ESR) français. Il fait des recommandations pour la tenue des soignants lors de la prise en charge d'un patient cas possible secrétant ou cas confirmé...
Uncertainty, risk analysis and change for Ebola personal protective equipment guidelines
In early September 2014, we were the first to publicly challenge the guidelines of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and those of many countries which suggested that medical masks be used by health care workers (HCWs) treating Ebola virus disease (EVD) (MacIntyre et al., 2014a). We argued in a previous editorial in the International Journal of Nursing Studies that in situations where there is uncertainty around the transmission mode, a risk analysis framework should be used to select personal protective equipment (PPE) and that the safety...
Do active safety-needle devices cause spatter contamination?
Exposure to blood and body fluids is an occupational hazard in healthcare. Although the potential for blood-borne virus transmission through needlestick injury has been widely studied, the risk of this occurring through spatter contamination from safety-needle syringes is not well understood. This report examines this risk from three commonly used safety needles and suggests that this presents a new and significant hazard. Further work should be commissioned to quantify this hazard and determine which type of safety needle would minimize spatter contamination following syringe discharge and safety...
Fighting Ebola: A Grand Challenge for Development
How NIOSH is Helping Design Improved Personal Protective Equipment for Healthcare Workers The current Ebola epidemic in West Africa is the largest in history and is unprecedented in many ways, including the large number of healthcare workers who have been infected while treating patients. The large scale of the epidemic, as well as the two healthcare workers who contracted Ebola while caring for the first case in the United States, has directed particular attention to the personal protective equipment (PPE) used by healthcare workers to reduce their risk of infection. PPE is designed to create...
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