Decontamination ; Disinfection ; Manikins ; Protective Clothing ; Personal Protective Equipment ; Health Personnel

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.

Objective. To determine the effectiveness of face mask with face shield, compared to face mask alone, in reducing transmission of SARS-CoV-2.

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.

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.

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.

BACKGROUND: The aim of this study was to evaluate the awareness of occupational hazards and personal protective equipment use among dental hygienists (DHs).METHODS: A total of 271 self-administered questionnaires were obtained from 280 DHs working at dental hospitals or clinics in Daegu and Gyeongsangbuk-do, Korea.RESULTS: The occupational hazards included work involving dust (94.1%), volatile substances (86.0%), noise (97.0%), and light-curing units (96.7%). The proportion of dental hygiene tasks that participants perceived as harmful were 42.4%, 51.7%, 9.2%, and 31.4% in the same order as above. The proportion of participants who used dust-proof masks during work involving dust was 1.1%. Those who wore gas-proof masks and gloves for work using volatile substances were 0.7% and 31.2%, respectively. Participants who used goggles for work involving light-curing units were 31.0%. None of the participants used ear plugs for work involving noise. A total of 22.9% of the participants recognized the Material Safety Data Sheet, while 79.7% had never been educated about harmful work environments.CONCLUSION: When compared to exposure status and perception of occupational hazards, the level of protective equipment use was very low. Extra measures to increase DHs’ use of personal protective equipment are necessary.
Daegu ; Dental Hygienists ; Dust ; Ear ; Eye Protective Devices ; Gyeongsangbuk-do ; Humans ; Korea ; Masks ; Material Safety Data Sheets ; Noise ; Occupations ; Oral Hygiene ; Personal Protective Equipment

PURPOSE: Personal protective equipment (PPE) is critical to protect healthcare workers from pandemic outbreaks. This study was designed to identify nurses' knowledge, attitude and perceptions on PPE. METHODS: Data were collected from 154 nurses working at a tertiary general hospital, where positively diagnosed and suspected patients were accepted and admitted during the Middle East Respiratory Syndrome Coronavirus outbreak in 2015. The PPE tool consists of 20 items for knowledge, and 5 each for attitudes and perceptions. RESULTS: Overall, knowledge for PPE was higher thanmoderate (76.95/100), but there was a lack for items related to powered air purifying respirator (PAPR). For attitudes, willingness to work in pandemic outbreaks was the most positive (4.04/5.00). Goggles and PAPR were perceived as themost uncomfortable barriers to work. There was no correlation between knowledge, attitude and perceptions, despite a strong positive correlation between attitude and perceptions. PPE training was identified as a factor to improve knowledge and attitudes on PPE. CONCLUSION: To respond to pandemic influenza, nurses need to expand their knowledge on PPE up to Level C, and be updated through regular training. Study findings suggest that repetitive studies targeting nurses and other healthcare workers at various hospital settings are necessary.
Coronavirus Infections* ; Delivery of Health Care ; Disease Outbreaks ; Eye Protective Devices ; Hospitals, General ; Humans ; Influenza, Human ; Middle East Respiratory Syndrome Coronavirus* ; Middle East* ; Pandemics ; Personal Protective Equipment* ; Ventilators, Mechanical

Background: In a low resource setting, strategies to optimize Personal Protective Equipment (PPE) supplies are being observed. Alternative protective measures were identified to protect health care personnel during delivery of care Objective: To provide list of recommendations on alternative protective equipment during this Coronavirus Disease 2019 (COVID-19) pandemic Methodology: Articles available on the various research databases were reviewed, appraised and evaluated for its quality and relevance. Discrepancies were rechecked and consensus was achieved by discussion. Recommendations: The use of engineering control such as barriers in the reception areas minimize the risk of healthcare personnel. Personal protective equipment needed are face shields or googles, N95 respirators, impermeable gown and gloves. If supplies are limited, the use of N95 respirators are prioritized in performing aerosol-generating procedures, otherwise, surgical masks are acceptable alternative. Cloth masks do not give adequate protection, but can be considered if it is used with face shield. Fluid-resistance, impermeable gown and non-sterile disposable gloves are recommended when attending to patients suspected or confirmed COVID-19. Used, soiled or damaged PPE should be carefully removed and properly discarded. Extended use of PPE can be considered, while re-use is only an option if supplies run low. Reusable equipment should be cleaned and disinfected every after use Conclusion In supplies shortage, personal protective equipment was optimized by extended use and reuse following observance of standard respiratory infection control procedures such as avoid touching the face and handwashing. The addition of physical barriers in ambulatory and triage areas add another layer of protection
Personal Protective Equipment ; Triage

Readiness of Health Care Staff: Statement 1. Family physicians and their staff should prepare themselves mentally, physically and emotionally before resuming clinic services. Prior to starting every clinic day, physicians and their staff should take their temperature and note respiratory symptoms. Statement 2. All clinical staff should be properly trained on proper use of PPEs, clinic disinfection, infection control and other safety procedures. Statement 3. Family Physicians should design an office management and operations plan that includes triage, patient flow, treatment and other patient care protocols including strict implementation of infection prevention and control procedures, management of PPE supplies and potential staff shortages. Statement 4. The clinic staff must inform their patients of the changes that may result from the new management and operations plan that will be made in the facility Clinic Procedures, Disinfection and Infection Control: Statement 5. After undergoing proper triage, non-COVID 19 patients entering the clinic should use a hand sanitizer, step on a foot bath or pad soaked in chlorine or any approved disinfectant solution at the entrance. All clinic staff, patients and accompanying persons should be wearing at least a mask inside the clinic. They should be instructed to avoid touching their face or mask and perform hand hygiene immediately before and after if cannot be avoided. Statement 6. Appropriate visual alerts or educational posters regarding infection control, proper handwashing, cough or sneezing etiquette should be visible inside the clinic. Statement 7. The clinic facility must have infection prevention and control measures that adhere to international and local standards. Statement 8. After appropriate triaging, a family physician when attending to a patient shall wear mask, single use gloves and eye protection while apron or gown is optional. It is up to the discretion of the family physician to use higher level of protection based on his risk assessment of the clinic environment and if resources are available. Clinical Services Statement 9. As much as possible, family physicians should continue all primary care services in the clinics. However, it is advisable to first limit the service to non-COVID-19 (suspect or diagnosed) patients. Patients needing COVID-19 assessment and management should be referred to appropriate facilities and follow the guidelines set forth by the Department of Health. Statement 10. A patient who consulted and whose symptoms were resolved may choose not come back for follow-up. Patients with chronic diseases may be followed-up at longer intervals if their illness is stable. Statement 11. Referrals for further assessment, diagnostic tests, or other procedures not available in the clinic must first be coordinated with the referral center/site
Personal Protective Equipment ; Triage ; Disinfection

PURPOSE: This purpose of this study was to identify the level of safe-handling of cytotoxic drugs and use of PPE (Personal Protective Equipment) among nurses at a regional cancer center in South Korea. METHODS: This was a cross-sectional descriptive study. The participants were 131 nurses who care for cancer patients undergoing chemotherapy. Demographic information, safe-handling of cytotoxic drugs and use of PPE were collected using questionnaires from May 7 to 25, 2018. RESULTS: Response rate was 98.4%. The mean age of the nurses was 28.2±4.4 years and their clinical nursing experience was 4.34±3.93 years. The mean scores out of 5 for the participants' safe handling of cytotoxic drugs was 3.73± 0.43. In use of PPE, the mean score of wearing gloves, masks, and gowns were 3.89±.77, 3.06±1.04, and 2.34±0.98, respectively. The main reason for not wearing PPE was ‘too busy’ (62.8%). The level of safe-handling of cytotoxic drugs was not significantly different according to any variables, but the use of PPE was significantly different according to age (p=.021). CONCLUSION: The findings showed that nurses had exposure to cytotoxic drugs in the processes of preparation, administration, cleaning of spills, and handling of patient waste. Education programs and continuous monitoring are needed to improve the use of PPE among nurses and trigger the appropriate motivation for consistent personal protection.
Cancer Care Facilities ; Drug Therapy ; Education ; Humans ; Korea ; Masks ; Motivation ; Nursing ; Personal Protective Equipment*

Air pollutants of concern include traffic-related air pollution, including particulate matter in respirable coarse and fine size fractions. There are no critical studies to date into associations between knowledge, awareness, and attitudes in using proper respiratory masks and prevalence of respiratory symptoms among urban street vendors in Thailand. In this study, we estimated adverse respiratory health outcomes among street vendors, in particular young adults, in Bangkok, Thailand, using a self-report questionnaire. Street vendors, who were not currently smoking and not having known diagnosed respiratory diseases, were recruited. They were selected from selected roadsides at Chong Nonsi, Bangkok. Participants (n = 30) reported having lower respiratory (50%), upper respiratory (37%), and other symptoms (70%). Also, 53% of participants had never used respiratory personal protective equipment (PPE: masks). Among those using PPE, all used masks not proper for particulate matter. Results suggested knowledge, awareness, and attitudes concerning proper PPE use needs to be increased among street vendors in Bangkok, Thailand.
Air Pollutants ; Air Pollution ; Commerce* ; Humans ; Masks ; Particulate Matter ; Personal Protective Equipment ; Prevalence ; Smoke ; Smoking ; Thailand* ; Young Adult*

Objective: We investigated the effect of personal protective equipment (PPE) on prevention of COVID-19 on health care workers (HCW) assigned in the wards, intensive care (ICU) and emergency room (ER). Methods: We searched MEDLINE, Cochrane CENTRAL as of 30 April 2021, as well as trial registers, preprint sites and COVID-19 living evidence sites. We included studies that compared use of PPE versus no use in the prevention of COVID-19. We screened studies, extracted data, assessed risk of bias and certainty of evidence using GRADE approach. Results: Five observational studies (three cohort and two case control) were found. There was moderate certainty of evidence that the use of Level 2 PPE (OR 0.03 [95% CI 0, 0.19]; 1 study, n = 5542) was protective for HCW. Level 2 PPE used N95 or higher standard respirators, goggles/protective mask, medical protective clothing and disposable hats, gloves and shoe covers. We also confirmed with moderate certainty evidence the protective use of N95 respirators (OR 0.035 [95% CI 0.002, 0.603]; 1 study, n = 493). There was very low certainty of evidence that demonstrated the protective effect of face shield (OR 0.338 [95% CI 0.272, 0.420]; 2 studies, n = 6717, I2 = 45% P < 0.00001). Very low certainty of evidence showed no significance difference with use of face/surgical mask (OR 1.40 [95% CI 0.30, 6.42]; 1 study, n = 186), gowns (OR 0.768 [95% 0.314, 1.876]; 1 study, n = 179) and disposable gloves (OR 0.62 [95% CI 0.13, 2.90]; 1 study, n = 179) when attending to patients with COVID-19. Conclusion There was lower odds of COVID-19 infection in HCW assigned to the wards, ICU and ER with possible direct contact with COVID-19 patients who wear Level 2 PPE including N95 respirators and face shields.
Personal Protective Equipment ; SARS-CoV-2 ; Pandemics

Objective: This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. Materials and Methods: MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. Results: A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE. Conclusion The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
COVID-19 ; Personal Protective Equipment ; Telemedicine