Monday, June 15, 2020

POTENTIAL HEALTH RISKS BEHIND THE MASK

Introduction By: R. Christenson, MD (From: "Holding the Front Line with Zero"- an essay by a covid health responder)

During the worst 2 months of the pandemic in New York, I spent countless double-shifts in a constantly slammed Long Island Covid Unit, tending to what seemed like a never-ending avalanche of critical cases.  The vast majority of our medical team was stretched to the very max of their professional tolerance, where each traumatic situation bred severe anxiety, PTSD and a rising count of suicide.

Exhaustion came in many forms; the drain on our mental composure ate away at our physical endurance as did the absence of sleep, zero nutrition plus the eminent fear and threat of death allaround us all. Add all that to the much reduced air supply from expired respirator use plus hedging on a number of serious complications from excessive CO2 intake - and you've got yourself the makings of some serious health conditions that may easily answer for what we simply call "burnout".


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The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts

Source: NIOSH SCIENCE BLOG/ CDCOriginal post on by Jon Williams, PhD; Jaclyn Krah Cichowicz, MA; Adam Hornbeck, MSN, APRN, FNP-BC, FNP-C; Jonisha Pollard, MS, CPE; and Jeffrey Snyder, MSN, CRNP.

Healthcare workers (HCW) and first responders often work long, physically and mentally exhausting shifts and are also required to wear personal protective equipment (PPE), which may include N95 filtering facepiece respirators (FFRs) elastomeric half-mask respirators, or powered air-supplied respirators (PAPRs). Particular features of PPE can impose a physiological (how the body normally functions) burden on the HCW which can be exacerbated by long work hours without adequate breaks for eating, hydration and self-care. HCWs should be provided regular opportunities to take breaks and a supportive environment to report symptoms related to their PPE use. For example, using an FFR for an extended period may cause dizziness (as well as other symptoms), which could compromise the worker, workplace, and patient safety. Dizziness is an important warning sign, as it can be caused by dehydration, hyperventilation (gasping for breath), elevated carbon dioxide [CO2] levels in the blood, low blood sugar, and anxiety, among other things.
When HCWs are working longer hours without a break while continuously wearing an N95 FFR, CO2 may accumulate in the breathing space inside of the respirator and continuously increase past the 1-hour mark, which could have a significant physiological effect on the wearer (Lim et al., 2006). Some of the known physiological effects of breathing increased concentrations of CO2 include:
  1. Headache;
  2. Increased pressure inside the skull;
  3. Nervous system changes (e.g., increased pain threshold, reduction in cognition – altered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels);
  4. Increased breathing frequency;
  5. Increased “work of breathing”, which is result of breathing through a filter medium;
  6. Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels);
  7. Reduced tolerance to lighter workloads.


Disclaimer: All content from "the above article (The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts" ) is republished in this associated blogsite / newsletter from its original source (NIOSH/CDC Science Blogand is done so with express permission from NIOSH/CDC and is in compliance with the source's agency regulations. Whereas use of any and all materials, information and links to the materials on the CDC [Centers for Disease Control and Prevention], ATSDR or HHS [Health and Human Services] websites, does not imply endorsement by CDC, ATSDR, HHS or the United States Government of this publication, the NY Cancer Resource Alliance, IntermediaWorx Educational Publications and other producers/publishers herein. 


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UV-C Light is used to disinfect & extend PPE life for reuse
UVC and the Coronavirus
By: Dr. Robert L. Bard & Lennard Gettz

A rising trend in hospital disinfecting (as well as in commercial areas and public institutions) is the installation and use of UV-C disinfecting technology. From small 8" x 10" boxes that extend the life of face masks in the healthcare field, to 8-foot transportable setups that fully sanitize hospital recovery and surgical rooms to (lately) subway trains covering a daily chemical-free sanitizing program.  Controlling infections with UV-C is fast earning public acceptance as a low-risk, non-chemical solution with significantly proven effectiveness.

Hospitals that use UV-light disinfection typically applies this technology as a 2nd step to cleaning and disinfecting measures.  This process is recognized by clinical infection control professionals and agencies to significantly mitigate infection risks associated with environmentally mediated transmission routes. (see complete article)


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RESOURCE 1: REPORTING BOGUS RESPIRATORS (part 1)
By: Stephanie Stevens (CDC / NIOSH / OD)


AD: Review on Counterfeit PPE for Health Responders-
sponsored by: The Advocacy for Professional Safety
According to Megan Casey, MPH, a nurse epidemiologist in NIOSH’s Personal Protective Technology Laboratory: Coronavirus is thought to spread through respiratory droplets produced when an infected person coughs or sneezes, but some medical procedures could potentially suspend virus particles in the air that healthcare providers are breathing. Wearing appropriate respiratory protection is a vital line of defense during these procedures. Counterfeit respirators can compromise the safety of anyone who uses them, including healthcare providers.

NIOSH receives reports of possible counterfeit respirators through a number of channels.This includes reports from manufacturers who are trying to protect the integrity of their own NIOSH approval. We may also be contacted by purchasers and users who have concerns about product or marketing materials. NIOSH staff may also identify instances of counterfeits or misleading information, including through web searches or from reports from stakeholders.  

When NIOSH becomes aware of counterfeit respirators or those misrepresenting NIOSH approval on the market, these respirators are posted online to alert users, purchasers, and manufacturers. As per our regulation, NIOSH only has authority over companies that hold a NIOSH approval. If the devices are not approved by NIOSH, we have no authority over them. We can only report these issues on our Trusted Source webpage for Counterfeit Respirators/Misrepresentation of NIOSH-Approval.


Resources to help identify counterfeit respirators:


Also see our expanded feature: The "Wild West" PPE Industry + A special feature on COUNTERFEIT RESPIRATORS


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SUGGESTED SAFETY GUIDELINES FOR MEDICAL OFFICES

Copyright © 2020- IntermediaWorx Inc. Educational Publications & NY Cancer Resource Alliance


As essential health and medical service providers, our community looks to us to set the standards when it comes to implementing safety measures, risk prevention strategies and sanitizing efforts.  We are all in the same fight to control the spread of pathogens and to preserve the health of our patients and our staff.  These same priorities align with our commitment to share these top recommended protocols for HEALTH & SAFETY which we assembled from a wide survey of safety‐minded colleagues. We urge you to review and consider these safety measures for your office.  Only together can we continue 'flattening the curve' and win this global health crisis- one office at a time!


1) BY APPOINTMENT ONLY:    As private practices are now beginning to re-open on a cautiously limited and adjusted schedule, communicate with your patients that you are officially open for in-person patient care and your new office hours. Adjusted scheduling allows you to better spread out all appointments for better crowd control and allows your staff time to disinfect and clean between patients. Also, emphasize NO WALK-INS.

2) TEMPERATURE CHECKS AT THE DOOR: More and more businesses and professional practices are now requiring temporal temperature checks at the door as an essential public safety measure.  The doorway is a major point of contact with the public at large- and one of your first lines of defense, starting with temperature screenings. Also, you can suggest all patients to check their temperature prior to traveling to your office - and stay home if they have above 101 degree reading.

3) PATIENTS ANNOUNCE THEMSELVES UPON ARRIVAL: When the patient reaches your facility for their appointment, request that they announce themselves via phone from outside. This gives your staff a chance to adjust in case the office is backed up- or if you can see them earlier. If possible, encourage patients to wait outside the building until their time is ready.

4) THE "NEW" WAITING ROOM: More and more doctors’ offices are now reducing the number of seats, and others are even eliminating their waiting rooms altogether.  Waiting rooms have been recognized as a potential ground for sharing bacteria and viral pathogens.  Reducing the wait capacity to the least number of patients (ONE or TWO max) is crowd-control and supports social distancing. 



Brought to you in part by the NY Cancer Resource Alliance and the Advocacy for Professional Safety, publishers of Prevention101.org







REFERENCES-
2) Visual Detection of Bacteria and Microbes;  https://aabme.asme.org/posts/device-quickly-detects-live-bacteria-for-life-saving-diagnosis

3) Acute Oxygen Therapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113909/

4) Healthcare suggers from PTSD... https://ohsonline.com/Articles/2020/05/19/Healthcare-Workers-Suffer-from-PTSD-and-Burnout-During-COVID19.aspx?Page=3

5) The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts  https://blogs.cdc.gov/niosh-science-blog/2020/06/10/ppe-burden/

6) Compliance Safety and Health Officers (CSHOs) for enforcing the Respiratory Protection standard: https://www.osha.gov/memos/2020-04-24/enforcement-guidance-decontamination-filtering-facepiece-respirators-healthcare

7) Study: Think Twice About Reusing KN95 or Surgical Masks- https://www.medpagetoday.com/infectiousdisease/infectioncontrol/87077?xid=nl_popmed_2020-06-16&eun=g1405490d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyUpdate_061620&utm_term=NL_Daily_Breaking_News_Active

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