Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach.

BACKGROUND: Health systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study's aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises. METHODS: We developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients' critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector. RESULTS: We found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up. CONCLUSION: We demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems' resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.

Improving compliance with personal protective equipment among anaesthetists through behaviour-changing interventions during the coronavirus disease 2019(COVID-19) pandemic.

Since 2020, the coronavirus disease 2019 (COVID-19) pandemic has seen many changes in our daily infection prevention behaviours so as to reduce healthcare-associated transmission of COVID-19 in patients and healthcare workers. In the early phases of the COVID-19 pandemic of 2020, there was much emphasis on compliant personal protective equipment utilization in the operating theatres (OTs) for COVID-19-positive patients. However, during this period, there was a lack of international validated protocols on the appropriate handling and subsequent storage of personal protective equipment in the context of aerosol-generating procedures in OTs for asymptomatic antigen rapid test (ART)-negative patients. Given the potential for transmission even with a negative ART due to the incubation period, our team developed a checklist of eye protection (e.g. goggles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve the compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital so as to prevent infection transmission and cross-contamination in the OT through education and behaviour-changing interventions. This quality improvement project took place over 19 weeks from June to October 2020 by our team of anaesthetists and nurse clinicians in the non-isolation OT setting. To analyse the problem, we performed a root cause analysis to understand attitudes and beliefs driving their behaviour. The top 80% of cited root causes for non-compliance then guided prioritization of resources for subsequent behaviour-changing interventions. Using the comprehensive infection control checklist, we conducted several plan-do-study-act cycles while implementing this new checklist amongst junior anaesthetists. A total of 227 assessments of junior anaesthetists were made in the care of asymptomatic ART-negative patients. Compliance with correctly handling goggles post-intubation started out as 33.3% in Week 1, which improved to 78.5% by Week 19. Compliance with goggle storage and face shield disposal started out at 13.6% in Week 1 and increased to 78.6% by Week 19. We attributed this improvement to education and behaviour-changing interventions. This quality improvement project focusing on improving compliance with personal protective equipment utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation OTs demonstrated the importance of interventions of education, persuasion, modelling, and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.

Wearable Sensor Node for Safety Improvement in Workplaces: Technology Assessment in a Simulated Environment.

Personal protective equipment (PPE) has been universally recognized for its role in protecting workers from injuries and illnesses. Smart PPE integrates Internet of Things (IoT) technologies to enable continuous monitoring of workers and their surrounding environment, preventing undesirable events, facilitating rapid emergency response, and informing rescuers of potential hazards. This work presents a smart PPE system with a sensor node architecture designed to monitor workers and their surroundings. The sensor node is equipped with various sensors and communication capabilities, enabling the monitoring of specific gases (VOC, CO2, CO, O2), particulate matter (PM), temperature, humidity, positional information, audio signals, and body gestures. The system utilizes artificial intelligence algorithms to recognize patterns in worker activity that could lead to risky situations. Gas tests were conducted in a special chamber, positioning capabilities were tested indoors and outdoors, and the remaining sensors were tested in a simulated laboratory environment. This paper presents the sensor node architecture and the results of tests on target risky scenarios. The sensor node performed well in all situations, correctly signaling all cases that could lead to risky situations.

Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments.

Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword "dental" was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous flora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE.

Evaluating workplace protection factors (WPFs) of different firefighter PPE interface control measures for select volatile organic compounds (VOCs).

Structural firefighters are exposed to a complex set of contaminants and combustion byproducts, including volatile organic compounds (VOCs). Additionally, recent studies have found structural firefighters' skin may be exposed to multiple chemical compounds via permeation or penetration of chemical byproducts through or around personal protective equipment (PPE). This mannequin-based study evaluated the effectiveness of four different PPE conditions with varying contamination control measures (incorporating PPE interface design features and particulate blocking materials) to protect against ingress of several VOCs in a smoke exposure chamber. We also investigated the effectiveness of long-sleeve base layer clothing to provide additional protection against skin contamination. Outside gear air concentrations were measured from within the smoke exposure chamber at the breathing zone, abdomen, and thigh heights. Personal air concentrations were collected from mannequins under PPE at the same general heights and under the base layer at abdomen and thigh heights. Sampled contaminants included benzene, toluene, styrene, and naphthalene. Results suggest that VOCs can readily penetrate the ensembles. Workplace protection factors (WPFs) were near one for benzene and toluene and increased with increasing molecular weight of the contaminants. WPFs were generally lower under hoods and jackets compared to under pants. For all PPE conditions, the pants appeared to provide the greatest overall protection against ingress of VOCs, but this may be due in part to the lower air concentrations toward the floor (and cuffs of pants) relative to the thigh-height outside gear concentrations used in calculating the WPFs. Providing added interface control measures and adding particulate-blocking materials appeared to provide a protective benefit against less-volatile chemicals, like naphthalene and styrene.

Evaluation of self-contained breathing apparatus (SCBA) weight on firefighter stamina, comfort, and postural stability.

Firefighters wear personal protective equipment to protect them from the thermal and chemical environment in which they operate. The self-contained breathing apparatus (SCBA) provides isolation of the airway from the hazardous fireground. National standards limit SCBA weight, however, integration of additional features could result in an SCBA exceeding the current limit. The purpose of this study was to examine the effects of increased SCBA weight on firefighters' physiological responses, work output, dynamic stability, and comfort. Completion of simulated firefighting activities induced a strong physiological response. Peak oxygen consumption was higher with the lightest SCBA than the heaviest SCBA. Few other physiological differences were noted as SCBA weight increased. Importantly, increased SCBA weight resulted in significantly more negative perceptions by the firefighters and a trend towards significance for the duration of work time prior to reaching volitional fatigue. These results should be considered when assessing changes to existing SCBA weight limits.

Increased SCBA weight above existing national standards resulted in negative perceptions by the firefighters, but not significant physiological changes after two simulated bouts of firefighting activity. SCBA weight had a nearly significant impact on the time firefighters worked before reaching volitional fatigue, with heavier SCBA trending towards decreased working time.

Anti-influenza Activity of Povidone-Iodine-Integrated Materials.

Personal protective equipment (PPE), including medical masks, should be worn for preventing the transmission of respiratory pathogens via infective droplets and aerosols. In medical masks, the key layer is the filter layer, and the melt-blown nonwoven fabric (NWF) is the most used fabric. However, the NWF filter layer cannot kill or inactivate the pathogens spread via droplets and aerosols. Povidone-iodine (PVP-I) has been used as an antiseptic solution given its potent broad-spectrum activity against pathogens. To develop PPE (e.g., medical masks) with anti-pathogenic activity, we integrated PVP-I into nylon-66 NWF. We then evaluated its antiviral activity against influenza A viruses by examining the viability of Madin-Darby canine kidney (MDCK) cells after inoculation with the virus strains exposed to the PVP-I-integrated nylon-66 NWF. The PVP-I nylon-66 NWF protected the MDCK cells from viral infection in a PVP-I concentration-dependent manner. Subsequently, we found to integrate PVP-I into nylon-66 and polyurethane materials among various materials. These PVP-I materials were also effective against influenza virus infection, and treatment with PVP-I nylon-66 NWF showed the highest cell survival among all the tested materials. PVP-I showed anti-influenza A virus activity when used in conjunction with PPE materials. Moreover, nylon-66 NWF integrated with PVP-I was found to be the best material to ensure anti-influenza activity. Therefore, PVP-I-integrated masks could have the potential to inhibit respiratory virus infection. Our results provide new information for developing multi-functional PPEs with anti-viral activity by integrating them with PVP-I to prevent the potential transmission of respiratory viruses.

Guarding skin under PPE: Mechanistic insights and technological innovations.

In the presence of diseases transmitted through respiratory droplets and direct contact, healthcare workers (HCWs) necessitate the use of personal protective equipment (PPE). For optimal safety, PPE should securely conform to the skin during extended wear. However, conventional PPE often lacks adequate air permeability and hygroscopicity, trapping heat and moisture emitted by the body within the enclosure. Such a hot and humid internal environment can induce skin damage, such as erythema, rash, pruritus, and itching among others, leading to microbial growth on the skin surface, the production of inflammatory mediators at the wound site and an increased risk of infection. This review strives to comprehensively elucidate the fundamental mechanisms triggering adverse skin reactions and their resultant manifestations. Furthermore, we explore recent advancements aimed at inhibiting these mechanisms to effectively mitigate the occurrence of skin lesions.

Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID-19 pandemic.

BACKGROUND: Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. MATERIALS AND METHODS: A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. RESULTS: The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). CONCLUSIONS: The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.

Being an older hospitalized patient during the COVID-19 pandemic - A qualitative interview study.

BACKGROUND: Older people hospitalized for COVID-19 are a vulnerable group due to the disease itself, aging and often loss of hearing and vision. Person-centered care, where patients have opportunities to communicate and participate in their own care, is important. However, because healthcare staff needed to wear personal protective equipment during the pandemic, to protect the patients and themselves, providing person-centered care was often difficult. This study aims to describe older hospitalized patients' experiences both of being cared for, while having COVID-19, and of the care provided by healthcare staff wearing PPE. METHODS: Fourteen older patients, over 65 years of age, were interviewed, and the data were analyzed using qualitative content analysis. The study adhered to Consolidated criteria for reporting qualitative research guidelines. RESULTS: Three subthemes and one overall theme, "The desire for survival overshadows difficulties", emerged in the analysis. The main findings revealed that the older hospitalized patients experienced the care they received from the healthcare staff as satisfactory. The older patients reported understanding and accepting that the pandemic situation meant that their ability to participate in their own care and communicate with healthcare staff were given lower priority. CONCLUSIONS: Older hospitalized patients need to be provided person-centered care, and situations such as a pandemic are no exception. Care tasks that are not acute in nature, e.g., planning for patients' return home, could be conducted by healthcare staff not required to wear PPE.

The "new normal" of hygiene measures at the end of the COVID-19 epidemic: a survey among French dentists.

OBJECTIVES: The COVID-19 epidemic upset the standards in terms of hygiene and protection in the dental office, bringing additional precautions for dentists. The objective of our study was to draw the "new normal" of hygiene measures at the end of the COVID-19 epidemic. MATERIALS AND METHODS: A self-administered questionnaire about transitional recommendations for oral care in the context of the COVID-19 epidemic was published online in private groups dedicated to French dentists. RESULTS: The 246 respondents understood the reasons behind those recommendations, since 10 out of 11 measures reached a mean score greater than 2.5 on a 0 (not at all) to 4 (absolutely) scale when it came to determining whether the measure made the practitioner feel safe and ensured patient safety. Besides, more of the respondents intended to maintain the measures than they were to apply them before the epidemic. CONCLUSIONS: The COVID-19 epidemic reshaped the relationship to hygiene and protection measures in the context of dental practices. The "new normal" of hygiene measures at the end of the COVID-19 epidemic will probably involve more protective measures than before. CLINICAL RELEVANCE: These results constitute interesting avenues for public health deliberation, which would make it possible to best adapt future health recommendations in order to define the "new normal" of hygiene measures in dental practices at the end of the COVID-19 epidemic. Therefore, it could have an impact on all practitioners in their clinical activities.

Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects.

Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.

Ozone application in different industries: A review of recent developments.

Ozone - a powerful antimicrobial agent, has been extensively applied for decontamination purposes in several industries (including food, water treatment, pharmaceuticals, textiles, healthcare, and the medical sectors). The advent of the COVID-19 pandemic has led to recent developments in the deployment of different ozone-based technologies for the decontamination of surfaces, materials and indoor environments. The pandemic has also highlighted the therapeutic potential of ozone for the treatment of COVID-19 patients, with astonishing results observed. The key objective of this review is to summarize recent advances in the utilisation of ozone for decontamination applications in the above-listed industries while emphasising the impact of key parameters affecting microbial reduction efficiency and ozone stability for prolonged action. We realise that aqueous ozonation has received higher research attention, compared to the gaseous application of ozone. This can be attributed to the fact that water treatment represents one of its earliest applications. Furthermore, the application of gaseous ozone for personal protective equipment (PPE) and medical device disinfection has not received a significant number of contributions compared to other applications. This presents a challenge for which the correct application of ozonation can mitigate. In this review, a critical discussion of these challenges is presented, as well as key knowledge gaps and open research problems/opportunities.

COVID-19 lockdown, personal protective equipment, hyper-hygiene and allergy.

Summary: At the beginning of SARS-CoV 2 pandemic, in the absence of "targeted" therapies, the national health authorities have introduced some measures aimed at reducing the spread of infection in the community (lockdown, social distancing, personal protective equipment (PPE), personal hygiene and disinfection of living environments). All the containment measures have led to both positive and negative effects in patients with allergic diseases. We believe that further studies should be undertaken to investigate the possible correlations between SARS-CoV-2 infection and allergy, from a broader perspective. In particular, the risk factors for the development of undesirable effects should be investigated, especially in healthcare professionals forced to use PPE and sanitizing agents for a long time. However, since the COVID-19 pandemic probably will not be short-lived, the use of such protective aids will necessarily be widespread even in the general population. Therefore, further studies on the materials used for the production of PPE and sanitizing agents would be necessary to reduce their sensitizing and, in some cases, toxic potential.

Prevention of skin damages related to personal protective equipment among healthcare workers: Summary of best-evidence practiced strategies.

AIM: To conduct a quality evaluation of the literature for the prevention of skin damage caused by personal protective equipment among healthcare workers and to summarise the best-evidence practice strategies to prevent it. DESIGN: Review. METHODS: Two researchers retrieved the literature from Web of Science, Public Medicine, etc., from the establishment of the database until 24 June 2022. Appraisal of Guidelines, Research and Evaluation II was used to assess the methodological quality of the guidelines. Expert consensus was assessed by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. By tracking the original study, the quality of practice recommendations and best-practice evidence information sheets were evaluated by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pre-grading and recommending level system. RESULTS: A total of 5476 studies were retrieved after duplications were eliminated. After the quality evaluation, 10 qualified studies were finally included. All consisted of two guidelines, one best practice information sheet, five practice recommendations, and one expert consensus. The evaluation results of the guidelines were both B-level recommendations. The consistency strength of expert consensus was moderate (Cohen's kappa coefficient = .571). Thirty best-evidence practised strategies were compiled for four elements, including cleaning, moisturising, prophylactic dressings and others. CONCLUSION: Our study evaluated the quality of the included studies and summarised the preventive measures of PPE-related skin lesions according to the recommendation level. The main preventive measures were divided into 4 parts and 30 items. However, the associated literature was rare, and the quality was slightly low. More high-quality research is needed to focus on healthcare workers' health and not just skin in the future.

Personalized 3D-printed frames to reduce leak from N95 filtering facepiece respirators: A prospective crossover trial in health care workers.

Correctly fitting N95 filtering facepiece respirators (FFRs) have become increasingly important in health care throughout the COVID-19 pandemic. We evaluated the hypothesis that personalized 3D-printed frames could improve N95 FFRs quantitative fit test pass rates and test scores in health care workers (HCWs). HCWs were recruited at a tertiary hospital in Adelaide, Australia (ACTRN 12622000388718). A mobile iPhone camera + app was used to produce 3D scans of volunteers' faces, which were then imported into a software program to produce personalized virtual scaffolds suited to each user's face and their unique anatomical features. These virtual scaffolds were printed on a commercially available 3D printer, producing plastic (and then silicone-coated, biocompatible) frames that can be fitted inside existing hospital supply N95 FFR. The primary endpoint was improved pass rates on quantitative fit testing, comparing participants wearing an N95 FFR alone (control 1) with participants wearing the frame + N95 FFR (intervention 1). The secondary endpoint was the fit factor (FF) in these groups, and R-COMFI respirator comfort and tolerability survey scores. N = 66 HCWs were recruited. The use of intervention 1 increased overall fit test pass rates to 62/66 (93.8%), compared to 27/66 (40.9%) for controls. (OR for pFF pass 20.89 (95%CI: 6.77, 64.48, p < 0.001.) Average FF increased, with the use of intervention 1-179.0 (95%CI: 164.3,193.7), compared to 85.2 (95%CI: 70.4,100.0) with control 1. Pass rates and FF were improved with intervention 1 compared to control 1 for all stages of the fit-test: bending, talking, side-to-side, and up-down motion. (p < 0.001 all stages). Tolerability and comfort of the frame were evaluated with the validated R-COMFI respirator comfort score, showing improvement with the frame compared to N95 FFR alone (p = 0.006). Personalized 3D-printed face frames decrease leakage, improve fit testing pass rates and FF, and provide improved comfort compared to the N95 FFR alone. Personalized 3D-printed face frames represent a rapidly scalable new technology to decrease FFR leakage in HCW and potentially the wider population.

Characterisation of superficial corneocytes in skin areas of the face exposed to prolonged usage of respirators by healthcare professionals during COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic healthcare workers (HCWs) have used respiratory protective equipment for prolonged periods, which has been associated with detrimental effects on the underlying skin. The present study aims to evaluate changes in the main cells (corneocytes) of the stratum corneum (SC) following prolonged and consecutive use of respirators. METHODS: 17 HCWs who wore respirators daily during routine hospital practice were recruited to a longitudinal cohort study. Corneocytes were collected via tape stripping from a negative control site (area outside the respirator) and from the cheek which was in contact with the device. Corneocytes were sampled on three occasions and analysed for the level of positive-involucrin cornified envelopes (CEs) and the amount of desmoglein-1 (Dsg1), as indirect measurements of immature CEs and corneodesmosomes (CDs), respectively. These were compared to biophysical measurements (Transepidermal water loss, TEWL, and SC hydration) at the same investigation sites. RESULTS: A large degree of inter-subject variability was observed, with maximum coefficients of variation of 43% and 30% for the level of immature CEs and Dsg1, respectively. Although it was observed that there was not an effect of prolonged respirator usage on the properties of corneocytes, the level of CDs was greater at the cheek than the negative control site (p < 0.05). Furthermore, low levels of immature CEs correlated with greater TEWL values after prolonged respirator application (p < 0.01). It was also noted that a smaller proportion of immature CEs and CDs was associated with a reduced incidence of self-reported skin adverse reactions (p < 0.001). CONCLUSIONS: This is the first study that investigated changes in corneocyte properties in the context of prolonged mechanical loading following respirator application. Although differences were not recorded over time, the levels of CDs and immature CEs were consistently higher in the loaded cheek compared to the negative control site and were positively correlated with a greater number of self-reported skin adverse reactions. Further studies are required to evaluate the role of corneocyte characteristics in the evaluation of both healthy and damaged skin sites.

MASKNE - Prevalence and association of causative factors during Covid-19 pandemic at a tertiary care hospital of Karachi.

OBJECTIVE: To assess the prevalence of mask acne in general population and healthcare workers, and the association of acne breakout due to mask-wearing with different factors. METHODS: The prospective, cross-sectional study was conducted from January to April 2022 at the Dermatology Department of Aga Khan University Hospital, Karachi, and comprised patients of both genders of all ages who received acne treatment during the period. Data was collected using a self-designed questionnaire having Cronbach's alpha value 0.789 which was filled by the subjects. Data was analysed using SPSS 19. RESULTS: Result: Of the 200 subjects, 152(76%) were females and 48(24%) were males. The overall mean age was 25.50±8.49 years. There were 122(61%) non-healthcare workers and 76(38%) were healthcare workers. Acne was prevalent in 157(78.5%) participants, and, of them, 123(78.3) were females. Significant association of acne breakout due to mask-wearing was found with regular mask change habit (p<0.001) and past history of acne (p<0.01). Participants who wore mask continuously for 6 hours or more came up with more complaints of acne (p<0.05). CONCLUSIONS: Prolonged and continuous use of the same mask for 6 hours or more could lead to acne eruption.

Waxing activity as a potential source of exposure to per- and polyfluoroalkyl substances (PFAS) and other environmental contaminants among the US ski and snowboard community.

BACKGROUND: Skiers and snowboarders apply waxes and solvents to their equipment to enhance glide across the snow. Waxing results in exposures to per- and polyfluoroalkyl substances (PFAS) and particulate matter, which have been associated with adverse health effects among professional wax technicians in Scandinavia. However, little is known about exposure among people who participate at other levels of sport, including recreationally, in other regions. OBJECTIVE: We sought to characterize wax-related exposures among US skiers and snowboarders who participate across numerous levels of sport to expand scientific understanding of environmental health risks among this population. METHODS: We used an anonymous electronic survey to evaluate wax-related exposures among US cross-country and downhill skiers and snowboarders. Specifically, we assessed (Fang et al., 2020): duration of time involved with each sport in any role (Freberg et al., 2013), intensity of wax-related exposures based on time spent in waxing areas, wax use, and wax type (Rogowski et al., 2007), frequency of fluorinated wax application, and (Freberg et al., 2010) use of exposure interventions. RESULTS: Participants tended to be long-term winter sports enthusiasts (e.g., median downhill skiing duration: 31 years). Nearly all (92%) participants personally applied some wax to their skis/snowboards and most applied waxes containing PFAS (67%) and solvents (62%). Ski professionals waxed the most pairs of skis with fluorinated waxes annually (median (IQR): 20 (1, 100)), though individuals participating recreationally also applied fluorinated waxes regularly. Exposure interventions were not widely used. SIGNIFICANCE: Waxing activities may pose significant risk of exposure to PFAS and other environmental contaminants among the US ski and snowboard community. Efforts are needed to reduce these exposures through changes to wax use patterns and broader adoption of exposure reduction strategies.

Can disposable masks be worn more than once?

Disposable facemasks are a primary tool to prevent the transmission of SARS-COV-2 during the COVID-19 pandemic. However, plastic waste generated from their disposal represents a significant environmental problem that can be reduced by maximizing the service life of disposable masks. We evaluated the effect of repeated wearing on the fitted filtration efficiency (FFE) of N95, KF94, KN95, and procedure/surgical masks. The FFEs of masks were compared following extended wearing with and without washing. Results reveal that most disposable facemasks can retain a high level of their baseline FFE after extended wearing, even after 40 h of wearing. Laundering disposable masks degraded FFE in some instances. We conclude that the durability of disposable facemask performance is considerably longer than their intended single use indication, suggesting that reusing disposable masks is a safe means of reducing plastic waste in the environment.