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Report Explores New Types of Respiratory Protection for Use in Health Care
A new report from the National Academies of Science, Engineering, and Medicine explores the potential for use of half-facepiece elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. The report examines two circumstances, routine and surge use, in which half-facepiece reusable elastomeric respirators could be considered in health care settings. A free prepublication copy of the report is available online . The study was done at the request of NIOSH and the National Center for Immunization and Respiratory Diseases...
Slips, Trips, and Falls Among Home Care Aides
A Mixed-Methods Study Objective: To address the gap of knowledge about slips, trips, and falls (STFs) among home care aides (HCAs) who work in clients' homes. Methods: This mixed method study used survey and focus group data of HCAs in a Medicaid-funded homecare program. Results: STFs were common with over 12% of HCAs reporting occurrence in the previous 12 months, of whom 58% fell to the ground. Both survey and focus group data identified ice, clutter, workload, rushing and other hazards. Focus group data explained the reasons for not reporting STFs, even among those who sustained injury,...
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
Influences on use of hand moisturizers in nurses
Background: Nurses are at high risk of hand dermatitis. Regular hand moisturizing can prevent dermatitis, but nurses' use of hand moisturizers is suboptimal. Aims: To establish (i) what beliefs about hand dermatitis and hand moisturizer use are associated with hand moisturizer use by nurses at home and at work and (ii) if hand moisturizer use behaviours in nurses are associated with the prevalence of hand dermatitis. Methods: We used a questionnaire to investigate nurses' knowledge, beliefs and behaviours regarding hand dermatitis and use of hand moisturizers. Results: The response rate...
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...
‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment
Background: Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers. Aim: To develop an evidence-based assessment and training tool for evaluating PPE ensembles...
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...
Occupational factors related to slips, trips and falls among home healthcare workers
Objectives: Slip, trip and fall (STFs) injuries are a significant problem in all industries, yet there are no significant prior reports assessing the relationship between occupational factors and STFs among home healthcare workers (HHCWs) who represent an ever increasing number of workers in the healthcare sector. The unpredictable nature of the work environment specific to HHCWs may lead to an increase in injuries from STFs. The purpose of this study was to quantify associations between occupational factors and STFs among HHCWs. Methods: This cross-sectional study of 870 HHCWs assessed relationships...
Disinfection of gloved hands for multiple activities with indicated glove use on the same patient
Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs. Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient. Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic...
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...
Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses
Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handling guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs. Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which...
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...
Are health care personnel trained in correct use of personal protective equipment?
Effective use of personal protective equipment (PPE) is essential to protect personnel and patients in health care settings. However, in a survey of 222 health care personnel, PPE training was often suboptimal with no requirement for demonstration of proficiency. Fourteen percent of physicians reported no previous training in use of PPE. Source: John, Amrita, Tomas, Myreen E., Cadnum, Jennifer L., Mana, Thriveen S.C., Jencson, Annette, Shaikh, Aaron, ... Donskey, Curtis J. (2016). AJIC : American Journal of Infection Control . http://dx.doi.org/10.1016/j.ajic.2016.03.031
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...
Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection
A systematic review and meta-analysis Background: Conflicting recommendations exist related to which facial protection should be used by health care workers to prevent transmission of acute respiratory infections, including pandemic influenza. We performed a systematic review of both clinical and surrogate exposure data comparing N95 respirators and surgical masks for the prevention of transmissible acute respiratory infections. Methods: We searched various electronic databases and the grey literature for relevant studies published from January 1990 to December 2014. Randomized controlled trials...
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...
Performance of Facepiece Respirators and Surgical Masks Against Surgical Smoke
Simulated Workplace Protection Factor Study Objective: Surgical smoke generated during electrocautery contains toxins which may cause adverse health effects to operating room (OR) personnel. The objective of this study was to investigate the performance of surgical masks (SMs), which are routinely used in ORs, more efficient N95 surgical mask respirator (SMRs) and N100 filtering facepiece respirator (FFRs), against surgical smoke. Methods: Ten subjects were recruited to perform surgical dissections on animal tissue in a simulated OR chamber, using a standard electrocautery device, generating surgical...
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...
Predictors of Adherence to Safe Handling Practices for Antineoplastic Drugs
A Survey of Hospital Nurses Background: Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Methods: Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work...
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