Break Scrub to Take That Phone Call?

Schirmer, Abigail; Swan, Courtney C; Hughes, Steven J.; Vasilopoulos, Terrie; Oli, Monika W.; Chaudhry, Sana; Gravenstein, Nikolaus; Giordano, Chris

doi:10.1016/j.jamcollsurg.2018.03.002

Cited by 16 publications

(11 citation statements)

References 17 publications

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“…Previous studies have used a similar germ-simulating product to visualize cross contamination in the food industry and the healthcare setting. 16 – 19 …”

Section: Approachmentioning

confidence: 99%

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus

Pacis

Azor-Ocampo

Burnett

et al. 2020

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19. PARTICIPANTS AND SETTING: This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory. APPROACH: We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period. OUTCOMES: We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings). CONCLUSION: Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

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“…Previous studies have used a similar germ-simulating product to visualize cross contamination in the food industry and the healthcare setting. 16 – 19 …”

Section: Approachmentioning

confidence: 99%

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus

Pacis

Azor-Ocampo

Burnett

et al. 2020

Journal of Wound, Ostomy &Amp; Continence Nursing

View full text Add to dashboard Cite

show abstract

“…A 2018 study published in the Journal of the American College of Surgeons examined the potential for the transfer of microbial contamination from an OR phone through a sterile, disposable surgical towel to the sterile surgical glove under it . In the three‐part study, the researchers first collected samples for culture in the middle of a surgery day in four ORs after the rooms had been cleaned.…”

Section: Scrubbed Personnel Holding a Phone With A Sterile Towelmentioning

confidence: 99%

“…The transmission rate of bacteria from the phones through the towel to the sterile gloves was found to be statistically significant ( P < .001), with a 47% transmission rate in 17 samples. The researchers concluded that sterile surgical towels are not an effective barrier to prevent the transmission of bacteria from the OR phone to the sterile gloves of a surgeon …”

Section: Scrubbed Personnel Holding a Phone With A Sterile Towelmentioning

confidence: 99%

Clinical Issues—June 2019

Anderson¹,

Cahn²

2019

AORN Journal

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“…In order to develop and inform best practices for personal protective equipment, various simulations of respiratory and aerosolized droplet dispersion have been conducted. However, it is unclear which of these methods of simulation, if any, approximate physiologic breathing or coughing [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. This is an important issue as data from these experiments are often used to inform guidelines for personal protective equipment (PPE) in the COVID-19 era.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have used complex setups that require the use of cell culture media, a micropump nebulizer, or optical particle counter [ 10 , 11 ]. However, given their complexity, low-cost setups with a UV-visible surrogate have been widely utilized [ 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. One procedure that was investigated was direct laryngoscopy intubation with and without an “intubation box” for protection against viral droplets and aerosol [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Physiological Relevance of Cough Simulators for Respiratory Droplet Dispersion

Patel

Yim

Garg

et al. 2020

JCM

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Various breathing and cough simulators have been used to model respiratory droplet dispersion and viral droplets, in particular for SARS-CoV-2 modeling. However, limited data are available comparing these cough simulations to physiological breathing and coughing. In this study, three different cough simulators (Teleflex Mucosal Atomization Device Nasal (MAD Nasal), a spray gun, and GloGermTM MIST) that have been used in the literature were studied to assess their physiologic relevance. Droplet size, velocity, dispersion, and force generated by the simulators were measured. Droplet size was measured with scanning electron microscopy (SEM). Slow-motion videography was used to 3D reconstruct and measure the velocity of each simulated cough. A force-sensitive resistor was used to measure the force of each simulated cough. The average size of droplets from each cough simulator was 176 to 220 µm. MAD Nasal, the spray gun, and GloGermTM MIST traveled 0.38 m, 0.89 m, and 1.62 m respectively. The average velocities for the MAD Nasal, spray gun, and GloGermTM MIST were 1.57 m/s, 2.60 m/s, and 9.27 m/s respectively, and all yielded a force of <0.5 Newtons. GloGermTM MIST and the spray gun most closely resemble physiological coughs and breathing respectively. In conclusion, none of the simulators tested accurately modeled all physiologic characteristics (droplet size, 3-D dispersion velocity, and force) of a cough, while there were various strengths and weaknesses of each method. One should take this into account when performing simulations with these devices.

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Break Scrub to Take That Phone Call?

Cited by 16 publications

References 17 publications

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus

Clinical Issues—June 2019

Assessing the Physiological Relevance of Cough Simulators for Respiratory Droplet Dispersion

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