Custom solution for personal protective equipment (PPE) in the orthopaedic setting: retrofitting Stryker Flyte T5 PPE system.

The coronavirus disease 2019 pandemic has meant that there is growing pressure on hospital resources, not least the availability of appropriate personal protective equipment (PPE), particularly face masks and respirator masks. Within the field of orthopaedic surgery, it is a common sight to see surgeons wearing 'space suits' (SSs) which comprise a helmet, hood and surgical gown. In this study, the authors made modifications to two different SS systems to incorporate a high-efficiency particulate air (HEPA) filter into the fan inlet to assess their potential as re-usable PPE systems for surgeons with regard to protection from a virus spread via respiratory droplets. The testing was carried out using particle counters upstream and downstream on a mannequin wearing two different SS systems with and without modifications to the fan inlet. The results show that using a layer of HEPA filter, cut to size and sealed to the fan inlet in the helmet, will reduce downstream particulates at the user's mouth by >99.5%; this is equivalent to a respirator mask. HEPA filter material is relatively cheap and can be used repeatedly, making this a viable alternative to disposable, and even resterilized, respirator masks in the setting of a respiratory-droplet-spread viral pandemic.

COVID-19 and mask in sports

INTRODUCTION: Due to the mandatory use of a mask, and the authorization to do outdoor sports in Catalonia, we aimed to assess the physiological impact of the hypercapnia hypoxia generated by the masks during aerobic sports practice. METHODS: Eight subjects (2 women, 6 men) were assessed at baseline with and without a mask, and immediately after a 21-flex test performed following the Ruffier protocol with a mask. Measures of HR (heart rate), concentration of O2 and CO2 inside the mask and SatO2 were assessed. The test was carried out in ambient air in squares in the city of Barcelona. RESULTS: A decrease in O2 was recorded, and when comparing the, baseline 20.9%, baseline mask 18.3%, post-exercise 17.8% (p < 0.001). An increase in CO2 in the three preconditions (464, 14162, 17000ppm; p < 0.001). Basal saturation O2 was 97.6±1.5% and post exercise 92.1±4.12% (p 0.02). CONCLUSIONS: The use of masks in athletes causes hypoxic and hypercapnic breathing as evidenced by increased effort during exercise. The use of masks during a short exercise with an intensity around 6-8 METS, decreases O2 by 3.7% and increases the CO2 concentration by 20%

No disponible

Under-mask beard cover (Singh Thattha technique) for donning respirator masks in COVID-19 patient care.

Tight-fitting filtering facepiece (FFP3) face masks are essential respiratory protective equipment during aerosol-generating procedures in the coronavirus disease 2019 (COVID-19) environment, and require a fit test to assess mask-face seal competency. Facial hair is considered to be an impediment for achieving a competent seal. We describe an under-mask beard cover called the Singh Thattha technique, which obtained a pass rate of 25/27 (92.6%) by qualitative and 5/5 (100%) by quantitative fit test in full-bearded individuals. Sturdier versions of FFP3 were more effective. For individuals for whom shaving is not possible, the Singh Thattha technique could offer an effective solution to safely don respirator masks.

Aplicación de presión positive continua en la vía aérea con el dispositivo no mecánico de Boussignac / CPAP generation by a non mechanical device: the Bousignac system

La CPAP (presión positiva continua en la vía aérea) consiste en establecer una presión supraatmosférica durante todo el ciclo respiratorio sobre la que el paciente ventila de forma espontánea. Su uso mejora los parámetros clínicos y gasométricos cuando se aplica con criterios adecuados de selección en el contexto de la insuficiencia respiratoria aguda (IRA) hipoxémica. Está demostrado que aplicar la CPAP precozmente disminuye la necesidad de intubación y las complicaciones asociadas, mejora la supervivencia y reduce la estancia hospitalaria y el coste asistencial. La utilización de la válvula de Boussignac para aplicar una CPAP se está extendiendo especialmente en el ambiente extrahospitalario y de urgencias por ser un dispositivo no mecánico, sencillo, de fácil aplicación y transporte, que puede administrar presiones suficientes para manejar al paciente hipoxémico [1]. Su aplicación es tan sencilla que no precisa un adiestramiento exhaustivo y los cuidados generales no difieren de otros métodos de ventilación mecánica no invasiva (VMNI). De hecho, ya existen en España ambulancias medicalizadas dotadas con este dispositivo, que la enfermera puede aplicar y manejar ella sola (AU)

CPAP (continuous positive airway pressure) is to establish a supraatmosferica pressure throughout the respiratory cycle on which the patient vent spontaneously. Its use improves the clinical and gasometrics parameters when applied with appropriate selection criteria in the context of respiratory failure acute (IRA) hypoxemic. It has been demonstrated that applying CPAP early, decreases the need for intubation and associated complications, as well as survival, reducing health care costs and hospital stay. The use of valve Boussignac for applying a CPAP is spreading especially in the delivered environment and emergencies as a device not mechanical, simple, easy to use and transport, which can manage enough pressures to manage the patient hypoxemia [1]. Its application is so simple that it does not need a comprehensive training and general care does not differ from other methods of mechanical ventilation noninvasive (adapted). In fact, already exist in Spain ambulances equipped with this device that can be applied and managed only by the nurse (AU)

Respiratory protection against bioaerosols: literature review and research needs.

Research on respiratory protection against biologic agents is important to address major concerns such as occupational safety and terrorist attack. This review describes the literature on respiratory protection against bioaerosols and identifies research gaps. Respiratory protection is a complex field involving a number of factors, such as the efficiency of respirator filter material; face-piece fitting; and maintenance, storage, and reuse of respirators. Several studies used nonpathogenic microorganisms having physical characteristics similar to that of Mycobacterium tuberculosis to analyze microbial penetration through respirators. Some studies showed that high-efficiency particulate air (HEPA) and N95 filters provided a higher level of protection than dust/mist (DM) and dust/mist/fume (DMF) filters. Flow rate and relative humidity appear to alter the level of penetration of microorganisms through respirator filters. The relationship between microbial penetration through respirator filters and the aerodynamic diameter, length, or other physical characteristics of microorganisms remains controversial. Whether reaerosolization of bioaerosol particles should be a concern is unclear, given the fact that one study has demonstrated significant reaerosolization of 1- to 5-microm particles loaded onto respirator filters. Respirator maintenance, storage, and decontamination are important factors to be considered when reusing respirators. The respiratory protection against biologic warfare agents such as anthrax in military and civilian situations is described.

Compliance with OSHA's respiratory protection standard in hospitals.

This study examined the incidence of violations of occupational safety and health standards for respiratory protection in hospitals. Data from Occupational Safety and Health Administration inspections that occurred in hospitals and resulted in violations of the respiratory protection standards were examined. From July 1, 1990, to June 30, 1995, the complaint rates for hazards in the workplace significantly increased. During 1990-1991, tuberculosis hazard complaint inspections rates were approximately 5 complaints per 1000 complaint inspections conducted. During 1994-1995, tuberculosis hazard complaint inspections rates were approximately 76 complaints per 1000 complaint inspections conducted, representing an increase of over 15 times. During this same period, the percentage of respiratory protection violations in relation to all violations doubled. Increased employee awareness of the hazards and current safety laws could have contributed to the increased frequency of employee complaints, leading to increases in inspections, violations, and fines. Employers must adhere to the current safety and health requirements specifically as they pertain to respiratory hazards and tuberculosis.

The role of respiratory protective devices in the control of tuberculosis.

In this comprehensive review, the authors describe various types of respirators and the major issues in their application to TB control, including the degree of protection they offer and cost. Recent recommendations regarding the use of respiratory protective devices also are discussed.

Aerosol filters.

This review discusses filter materials, filter mechanisms, filter testing and applications of filters in medicine. While many applications are satisfactorily solved, there seems to be a research need for generating particle free air to relieve pains from people suffering from allergens and standardization of filter testing procedures for filters used in exhalation lines with humid air.