Monday, June 15, 2020

Respirators vs. Surgical Masks- What's the Difference?



Respirator vs. Surgical Mask - What's the Difference?
Written by: Dr. Robert Bard, MD, PC, DABR, FASLMS

Months into the pandemic, we have confirmed that following CDC safety and prevention guidelines of wearing some approved form of face covering in public (or around others) is directly connected to the reduction and control of Covid-19 infection rates.  Time and time again, scientists and medical experts have valid proof that viruses travel through micro-droplets in the form of airborne contaminants. 


Fact: ANY PPE is better than NO PPE!  The science of prevention states that measures toward a reduction in risk can greatly support life-saving others - and yourself.  Meanwhile, discerning the difference between face coverings, specifically MASKS vs RESPIRATORS can be useful in identifying which situation to use which type of mask. There is a significant difference between the two, and wearing one vs. the other provides differing results.

The FDA defines a surgical mask as a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets (NOT MICRO-DROPLETS), splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others. While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.

Meanwhile, an N95 respirator is an "efficient filter and a respiratory protective device designed to PROTECT YOU from airborne particles". Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s because it is actually rated by NIOSH to keep out or resist an estimated 95% of the harmful particulates in the air. [11]



KILLER BREATH CONTAINED GLOBALLY BY "MASKING TOGETHER"
by: Dr. Pierre Kory, M.D., M.P.A.

As far as respiratory protection, there has been quite a bit of confusion about MASK vs. RESPIRATOR in the early stages of COVID-19.  This was not just in the general public, but among many hospitals and infection control departments.  

Initially, there was a great deal of reluctance in accepting the belief that COVID-19 could be transmitted via airborne means.  To explain this, viral infections (like the flu) are considered to be transmitted by what's called large droplets. When speaking, we all force out a little spittle with sizes ranging from visible to microscopic- such that you don't see leaving the mouth. The larger droplets do not travel far and do not “float” in the air and thus, social distancing is highly effective at preventing contact with a contaminated droplet reaching your oral mucosa or face. 

However, AIRBORNE droplets are tiny, and can float and linger in the air for a period of time.  Airborne micro-droplets can be directly inhaled along with the virus without any person-to-person contact and even at large distances of separation. Just sharing the same room with an infected person, you can inhale the floating particles that they are exhaling, if they are not wearing a mask. This is what makes this infection different and much more dangerous than others. However, if an infected person near you is wearing a mask, even a simple one, the mask will trap the larger droplets so that smaller droplets are not created and will not become airborne. To achieve this protection, you need near 100% mask-wearing in confined indoor spaces.


Without near universal mask wearing, you get these "super spreader" events where someone went to choir practice and 52 of the 60 people there all came home sick. That's because tiny droplets were out in the air and floating. The only way to protect yourself from an airborne sized droplet emitted by a non-mask wearer is by you yourself wearing an N95 respirator. In such a situation, your N95 will filter out those tiny little particles from entering your airways. If fitted properly the N95 blocks 99% of the particles- and there's significant proof that the rates of infection among healthcare workers went drastically down after we started using N95 everywhere around COVID patients, none of whom were wearing any kind of mask which would have helped protect us.



Covid-19 : LaVision imaging technique shows how masks restrict the spread of exhaled air.  The primary way of person-to-person corona virus transmission is via aerosols or small droplets created by breathing, sneezing or coughing. The reach of exhaled air can be effectively reduced using a face mask as shown in the video. A simple Schlieren imaging technique is applied to visualize the air flow caused by a person breathing and coughing. Using a face mask the exhaled air flow is blocked reducing effectively the risk of infection. 



At a certain point, I was convinced that the entire world had to get an N95 mask to achieve sufficient protection from transmission within indoor spaces- but then I learned later that using a standard cloth mask (or a even a surgical mask) actually DOES work. And the reason why the data's showing such masks work is that if you look at a lot of the countries which successfully controlled the spread of this infection, all of those countries had mandated a hundred percent use of general face covering throughout the population. The way it works is, when two or more people are using a NON-N95 mask in a room, those large droplets would be trapped in the mask- not transmitting and not forming micro-particles that go airborne! By me wearing a mask, it actually protects YOU from me making those little airborne particles. 

An effective scarf or home-made cloth mask may not have the same makeup as the N95, but they DO block about 60 to 70% of the particles. So they're not perfect, but what the data shows and what the epidemiological data shows from all those successful countries that controlled their cases is that as long as everybody wears a mask, any type of mask, the combined performance of two people  with those masks from each other actually reduces the risk of transmission to a very, very low level.



CONTRIBUTORS

ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist
Dr. Bard received the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. 

PIERRE KORY, M.D., M.P.A.
Dr. Kory is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma and Life Support Center at the University of Wisconsin where he was an Associate Professor and the Chief of the Critical Care Service. He is considered a pioneer and national/international expert in the field of Critical Care Ultrasound and is the senior editor of the widely read textbook “Point-of-Care Ultrasound” (winner of the President’s Choice Award for Medical Textbooks from the British Medical Association in 2015).  Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group (flccc.net) composed of 5 critical care experts that devised the COVID-19 treatment protocol called MATH+. (www.covid19criticalcare.com/)


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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)


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

11) https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks

©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Tuesday, June 9, 2020

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 100 degree reading (recommendation by the CDC). 

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. 

5) (NEW) REMOVE MAGAZINES & NEWSPAPERS: Take away any materials in the waiting room that may land on a patient's hands.  Reading material is a potential breeding ground for traveled viruses from others.

6) MASKS & OTHER PPE: The current law of “NO MASK = NO SERVICE” applies to all indoor professional or commercial settings where masks (nose & mouth covering) are required AT ALL TIMES. And when working with patients under treatment, make sure to wear clinical-grade protective gear such as gloves, protective gowns and face shields as standard precaution. 

7) HAND SANITIZING: Regular hand-washing 
(20 seconds) is highly advised for reducing contamination from pathogens both for the public and your staff. In addition, your office should have visible & easy access to hand sanitizers in every room especially for all office occupants. 

8) REDUCE IN-PERSON TALKING: As viruses are widely recognized to be transported by one’s BREATH and atomized saliva, a major part of Prevention means limiting verbal exchange between patients and medical staff to the absolute essential minimum. A safe alternative is discussing anything administrative BY PHONE prior to the appointment.   

9)  PAPERLESS OFFICE:  Another means of reducing person-to-person contact and minimizing physical engagement with patients. Transmitting and receiving patient forms and payment processing via email before the visit is a proven and safe office solution (PAPERLESS OFFICE) that streamlines workflow and reduces patient time spent in the office. 

10) TELEMEDICINE: A sustainable tech option that is spiking in popularity, TeleMedicine is a nationally billable alternative to the (now risky) face-to-face consultation and post-procedure doctors’ visit.  Digital and video communication with patients is an intelligent use of our existing web & video technology.  Telemedicne supports the elimination of the patient's travel time and is a completely SAFE preventive measure from any possible exposure from a waiting room or public contact.



11) OFFICE DISINFECTING REGIMEN: Stock up on disinfectant wipes and sprays for your staff’s daily maintenance.  Upgrade your office cleaning routine to include a regular hospital-grade sanitizing regimen.  This includes use of industrial rated anti-microbial products. Offices and hospitals can hire outside disinfecting companies to come in and conduct disinfecting services. Research the many available products and sanitizing vendors in your area. Also, explore the many new disinfecting technologies (their efficacy and pros and cons) - including liquid sprays, electrostatic applications, UV-C (Ultraviolet) Lamps and Negative Air Ionizing Filters.  [CDC also recommends increasing the frequency of disinfecting surfaces.]


12) (NEW) QUESTIONNAIRE / PATIENT'S CURRENT CONDITION
Sometimes, clerical measures can be a preventive tool.  Many doctors offices are requiring patients to fill out and sign a form asking about the patient's health condition and history with Covid-19. By their signature, they are attesting legally to the validity of their responses, committing them on record as to their level of risk to others and to themselves.

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THE DAILY SELF-CHECK KIT
In keeping with daily maintenance in our current pandemic, "knowing is half the battle" and is a useful weapon against an invisible enemy. According to the NYS.gov site, PREVENTION protocols include MATILDA'S LAW which includes:

- Remaining indoors
- Going outside for solitary exercise
- Pre-screening all visitors by taking their temperature
- Wearing a mask in the company of others
- Staying at least 6 feet from others
- Do not take public transportation unless urgent and absolutely necessary in addition to washing your hands and wearing a cloth face covering or a mask around others. 

As we all agree that illnesses can be unpredictable (and even SNEAKY), to know your body requires a few essential tools.to use daily to check your current state of health. (see graphic INSERT) This includes a PULSE OXIMETER to check your daily oxygen saturation of your blood. This helps identify if there is something wrong with your lung functions. Next, check your temperature at least once a day. If it is possible to have more than one thermometer, this allows you to get a confirmation reading as you should never trust any thermometer to always be accurate. Lastly, a blood pressure monitor to track high BP or irregularities - considering the coronavirus hs a cardio-pulmonary disorder (that means lungs and heart).

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TALK ABOUT SAFETY... See what other docs are saying

NO-TOUCH TECHNIQUE
“Without a doubt, this pandemic has awakened much change in the way we do just about anything, and thinking SAFETY is a big part of that! Our patients appreciate our converting to an ONLINE platform for all patient registration forms... once we went completely digital,  you have a true “no touch” and "no talking"  technique where patients walk directly in to an exam room and no stopping at the front desk and no MA’s or techs needed.  It’s a direct walk into treatment then out the door.”  
– Dr. Stephen Chagares, Breast Cancer Surgeon- NJ (drchagares.com)


A TIMELY REVOLUTION IN METHODS
“- I’ve always felt that there are many areas in patient care that could use an upgrade... this  pandemic made us re-evaluate every part of our work process for better safety and cost efficiency. This  includes our current resources like TeleMedicine- where remote consults and digital file have become such a blessing as it saves patients travel time and $$ while keeping everyone safe from unnecessary risk and exposure." 
Dr.Robert  L. Bard, Cancer Diagnostic Imaging- NYC (Cancerscan.com | TelemedScans.com)



LEADING BY EXAMPLE
"It is imperative to institute good safety measures in medical office settings as we begin to navigate this COVID-19 pandemic and help guide the country through the reopening phases.  As healthcare professionals- it is our duty to set the example for others to follow.  We can provide a framework and high standards of health and safety ideas that can be mirrored in all office settings, stores, schools , banks and other industries." 
- Juanita Mora, MD, Volunteer National Spokesperson, American Lung Association


PREVENTIVE ADJUSTMENTS
“The landscape for treatment has changed…Patient visits are spaced so that no one is in the waiting room. Patients  must wear a mask upon entrance and throughout the course of the visit and so does the caregiver or attendant. After each visit, the room is wiped down with appropriate sanitizers; careful to not overdo it which might cause respiratory problems. Common surfaces (doorknobs etc) are also wiped” 
– Dr. Richard Kushner, Podiatrist - NYC


PATIENT CONFIDENCE
"It is critical that every patient “touch point” is educational and science based. Examples include; the first email sent out announcing your practice re-opening, the screening questions that are asked prior to the patient’s first visit,  the patient’s greeting/screening at your entrance, the handwashing station, the waiting and patient areas. Take the time to make sure your staff is comfortable with the procedures implemented."
Dr. Carol Stillman Physical Therapist and owner of Sutton Place Physical and Aquatic Therapy.


SMART SYSTEM UPGRADE
"Promoting SAFETY GUIDELINES in any health practice (especially during this Pandemic) is everyone's duty in our community-- where we all need to do our part to help minimize the risk of contamination. Policies like checking temperatures at the door and having maintaining sanitizers and PPE's for the staff gives the patients peace of mind knowing they are walking into a safety conscious office.  It's an opportunity for providers to lead by example!" 
 Jessica GlynnLicensed clinical social worker/psychotherapist- NYC (jagtheracoach.com)  

For  the  latest  CDC updates,  additional  information  and  safety  recommendations  for  your  medical  office,  visit:  PREVENTION101.ORG and review our CDC SAFETY LINKS.  This list of suggested Safety Guidelines for healthcare offices  is published by The Advocacy for Professional Safety‐ a branch of the NY Cancer Resource Alliance and IntermediaWorx  Educational Publishing. (c) Copyright, 2020‐ All Rights Reserved. 
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VIDEO EXTRA:
"The Power of Prevention of Covid-19 is in YOUR HANDS"
Source: MD Anderson Cancer Center

You have the power to reduce your risk of infection by washing your hands often. Watch how a blacklight reveals what improper hand washing can leave behind. According to Dr. Christina Le-Short of MD Anderson Cancer Center, "Cancer patients are at greater risk of developing complications from respiratory viruses... Effective hand-washing is your best defense against germs that cause the flu or Covid-19".

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A WORD FROM THE TOP
As the country aims at opening more and more areas of business, the concern for safety is at its highest.  Commercial business and health centers alike are following the many safety protocols recommended by city, state and federal leaders with the hopes of quelling the threat of a Covid recurrence, bringing us all back to another shut-down.

In a NY State press conference on 5/12, Governor Andrew Cuomo presented his goals for reopening lower New York with safety conditions, starting with a push to maintain social distancing and valuing the importance of continued face covering.  "Out of respect to you," he started, "I wear this mask.  The mask says I respect the nurses and the doctors who killed themselves through this virus to save other people- all essential workers who get up every day to do their job so I can stay safe... it's not about ME-- it's about WE!" ( see complete video LINK)

A recent CDC report about Screening Patients for COVID-19 at Intake stated, "If there is widespread community transmission of COVID-19, facilities can consider instituting active temperature monitoring by having a staff member check the patient’s temperature immediately upon arrival at the door and when the patient is first asked about symptoms".  (ref. link: CDC Screening PatientsIn addition,  masks, social distancing and disinfecting work areas are part of this new critical infrastructure.  (See complete CDC Interim Guidance)

In addition, the NYS Dept of Health also published Covid-19 Guidance for Medical Providers about infection control.   "...When engaging a client (patient), staff should use alcohol-based sanitizer with at least 60% alcohol prior to entering the home and should wear a face mask, if available.  Staff should attempt to keep at least six (6) feet away-- [and] should also remind everyone to practice appropriate hand hygiene and to avoid touching their face".  From a May 2020 update, the DOH also encourages Telemedicine and TeleHealth technologies whenever possible. (link).- Also see Managed Care Organization Contracting and Surveillance Relief.  (DOH link

Also see: Senator Biaggi’s 6/4 COVID-19 Update: NYC has Zero Confirmed COVID-19 Deaths for first time since March 11




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©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Tuesday, June 2, 2020

GERMOPHOBE'S PARADISE & THE BOOM OF THE SANITIZING MARKET

by: Robert L. Bard, MD

In the era of Covid, where fighting invisible airborne killers are recognized as our new global reality, we call on the scientific community to offer logical innovations to thwart the pandemic issue.  While a vaccine for the Coronavirus remains in research phase, our battle leans heaviest in targeting prevention, safety and protection protocols.

As we continue to reach new levels of "the curve", businesses and industries continue to suffer the economic downturn while a select group are receiving the BOOM of a lifetime.  Such is the case for web-based technologies (temporarily replacing social gathering), PPE manufacturers, pharmaceuticals and the many marketers of SANITIZING PRODUCTS.

As market trends are aligned with consumer behavior, the March lock-down prompted panic-shopping and premature hording frenzy.  This led to empty shelves nationwide, further raising the level of desperate consumer activity.  But recent signs are showing a strong rebound of fulfillment activity in stores with a re-growing supply of many health essentials.

Manufacturers old and new are fast responding to the consumer's emotion-based reactive shopping behavior.  Domestic popular brands and generic house brand producers (white label manufacturers) are now showing increased presence in retail store shelves with more stores finding little need to limit customers from over-buying. The War Powers Resolution Act has been said to help motivate new American suppliers and producers by expanding their product lines to include creating PPE's and other health & sanitizing products.

...BUT WHAT ARE THEY SELLING US?
In the case of marketing sanitizers, a phrase like "Kills 99.9% of bacteria " is one of the most common sell-phrase used to describe antimicrobial or antiseptic products. Others brandish even more pointed descriptions like germicidal, fungicidal, virucidal, or (even) tuberculocidal to paint an even higher scientific picture to lure buyers.   A wise word of caution to consumers is to READ the active ingredient in all these packages as part of recognizing exactly what we are exposing ourselves to-  and knowing how they can affect us.

Fact: Not all sanitizers are the same!  Types of  ANTIMICROBIAL SANITIZERS on the market fall into one of five base categories: alcohol, chlorine (bleach), phenol, quarternary amine and quarternary amine + alcohol. (The effects of these chemicals and their potential health effects will be discussed in part 2 of this report.)

* Benzalkonium Chloride
* Isopropyl Alcohol
* Ethyl Alcohol (ethanol)
* sodium hypochlorite
* Didecyldimethylammonium Chloride
* Alkyl Dimethyl Benzyl Ammonium Saccharinate

COMMERCIAL SANITIZING: PREVENTION OR MAINTENANCE
Entering the warmer months of 2020, we are all (by now) programmed by prevention to wash our hands incessantly, mask up in all public and shared areas and "think contagion" when touching just about anything.  Where health means supporting our immune system to fight off any bacteria or virus,  this fight also means stepping up our cleaning practices to stricter measures like sanitizing , disinfecting and sterilizing of our homes and work areas.

For commercial areas, an influx of cleaning companies are majorly promoting "disinfecting services for covid".  The industry term HAI (healthcare-associated infections) is often used in healthcare and hospitals to apply to disinfecting solutions and sanitizing standards.  Upon review of some of the top advertised service providers, certain products and sanitizing protocols are offered to manage HAI rates.

These products are either "fogged" in an enclosed space, sprayed on contact with an "electrostatic applicator" or wiped on surfaces.  One common product is called Noroxycdiff - a hospital grade, EPA registered disinfectant for use against SARS-CoV-2. The main active ingredient in our chemical is Hydrogen Peroxide. Another is BIOCIDE 100, a product used for remediating mold. Meanwhile other companies offer applying VITAL OXIDE through an Electrostatic Sprayer or hospital grade wipes like CLOROX HEALTHCARE VERSASURE or OXIVIR wipes.  

Other products are also trending on the market like Nano-wipes including the common brand "Bio-Kil" used in high-demand areas such as ICU. "After application of Bio-Kil, the bacterial burden declined in both groups, although the reduction was greater in the study rooms as compared with the control rooms (p = 0.001). During the pre-intervention period, 16 patients were admitted to control rooms and 18 patients to study rooms. After the intervention, 22 patients were admitted to control rooms and 21 patients to study rooms. The number of cases of new-onset sepsis declined in the intervention group (from 33% to 23.8%), but increased in the control group (from 25% to 40.9%); however, there was no significant difference in incidence of new-onset sepsis between the study and control rooms after intervention. Application of Bio-Kil reduced the environmental bacterial burden and MDROs in ICUs. Further studies are needed to evaluate the efficacy of this nanotechnology-based disinfectant in reducing HAIs. [2]|

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SANITIZING WITH UV-C LIGHT
In a recent interview with American Health Supply Co. (a PPE supplier), a unique concept of using ultraviolet light to disinfect surgical and respiratory masks for repeated use extends the life of what is currently a rare, life-saving commodity.

Hospitals that use UV-light disinfection after cleaning and disinfection standard protocol have actually significantly mitigated infection risks associated with environmentally mediated transmission routes. [6]  Investigations of the bactericidal effect of sunlight in the late 19th century planted the seed of air disinfection by UV radiation. First to nurture this seed was William F. Wells, who both discovered the spread of airborne infection by droplet nuclei and demonstrated the ability of UVGI to prevent such spread. Despite early successes in applying UVGI, its use would soon wane due to a variety of reasons that will be discussed in this article. However, with the enduring research of Riley and others, and an increase in tuberculosis (TB) during the 1980s, interest in UVGI was revitalized. With modern concerns regarding multi- and extensive drug-resistant TB, bioterrorism, influenza pandemics, and severe acute respiratory syndrome, interest in UVGI continues to grow. Research is ongoing, and there is much evidence on the efficacy of UVGI and the proper way to use it, though the technology has yet to fully mature. [5]

Dr. Christopher Centeno of Regenexx, a prominent stem cell therapy center in Boulder, Colorado subscribes to the benefits of UV-C disinfectant lighting. “Our clinic began researching UVC light sterilizers about two months ago, but they were very expensive and hard to get. Hence, I decided to build my own. This project cost $400 with parts from Amazon that took a week to get. The average commercial price of an exam room sterilizer is about $5,000 and these take months to be delivered after ordering.  I’ve tested our DIY unit with standard UV dosimeter cards used in hospitals and it pumps out enough UVC light to kill MRSA.”

An early study showed that NAIs caused a significant amount of biological decay of the bacterium Serratia marcescens. Exposure to NAIs showed inactivation or growth inhibition of the bacteria E. coli, Candida albicans, Staphylococcus aureus, P. fluorescens [96,97,98,99,100] and has a lethal effect on starved Pseudomonas veronii cells. NAIs prevented 60% of tuberculosis (TB) infection and 51% of TB disease. Except for the inhibition effect of NAIs on bacteria, reports also showed that NAIs inhibited the growth of fungi and viruses. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213340/)

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PREVENTION 1: IMMUNE SYSTEM SUPPORT
By: Dr. Jesse A. Stoff


Basic biology attributes any contracted sickness or disease to a WEAKENED and COMPROMISED IMMUNE SYSTEM.   Our body's immune system accounts for approximately 1% of the body's 100 trillion cells.  The different cell lineages that develop all share one common objective: to identify and destroy all substances (living or inert) which are recognized as not being part of what "should be in the body.” Whether it is an abnormal cell or what are perceived as dangerous or damaged cells, they are actively hunted down and destroyed by effector cells of the immune system.

Imagine having your own personal army of cells in your highly advanced defense system, working against outside invaders or abnormal cells where each cell type (over one hundred and eighty-seven recorded) carries their own dedicated function. This specialized team of cells work together to fulfill the complex mission of protecting the body from infection or illness each day.

During this (and any) pandemic, supporting and boosting the immune system is priority 1. Improving the health of the immune system means your body will become more resistant to incoming diseases. Making your immune system stronger is not a linear program, because you are dealing with a complex network of factors in your body that needs to be addressed. However, there are certain measures you can take to boost the immune system.  If you have to do one thing to boost your immune system, it should be maintaining a healthy lifestyle because there is no better and natural way for the improvement of the immune system. Avoid smoking, eat healthy, limit your alcohol consumption, maintain your weight and blood pressure, and get enough sleep.

Make sure that you are consuming all those important micronutrients which are important for bolstering the immune system. If you can’t manage this through your diet alone, go for supplements.  Vitamin D is often referred to as the sunshine vitamin because our body can actually manufacture vitamin D. It's a fat-soluble vitamin, and it's metabolized in our body from various fat-soluble steroid complexes, as they're referred to. And vitamin D is then metabolized in the skin and split from some of these molecules into the active form of vitamin D- which then has a wide range of effects on basically every single cell in our body. Vitamin D isn't just about having strong bones and strong teeth; vitamin D also has some really wonderful effects from a preventative medical point of view.
(For complete articles on the immune system, visit Dr. Stoff's Immunology Today blogsite: http://immunologysmarts.com/)


Ref: 
1) A Comparison of Commonly Used Surface Disinfectants
https://www.infectioncontroltoday.com/environmental-hygiene/comparison-commonly-used-surface-disinfectants

2) Bio-Kil, a nano-based disinfectant, reduces environmental bacterial burden and multidrug-resistant organisms in intensive care units-  Journal of Microbiology, Immunology and Infection https://www.sciencedirect.com/science/article/pii/S168411821630038X

3) Silver nanoparticles as an effective disinfectant: A review (Pub med)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127744/


4) Top ten disinfectants to control HAIs
https://www.hospitalmanagement.net/features/featureppc-disinfectants-hai-globaldata/

5) The History of Ultraviolet Germicidal Irradiation for Air Disinfection 

6) Evaluation of an Ultraviolet C (UVC) Light-Emitting Device for Disinfection of High Touch Surfaces in Hospital Critical Areas https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801766/


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