Evaluating WHO prescribed sanitary inspection templates for assessing contamination risks in tubewells with handpump - case of 9 Indian districts.

WHO prescribes Sanitary Inspections in recommended formats for assessing contamination risks in Tubewells installed with handpump that often constitute primary drinking water sources in rural and remote areas. Sanitary inspections are easy alternatives to costlier and technically demanding laboratory water quality analysis. However, their efficacy remains uncertain despite decades of widespread usage. This study evaluates sanitary inspections by assessing contamination risk in 324 Tubewells with handpump across 9 districts in India. Results indicate that 62% of sampled sources were safe in lab analysis, despite sanitary inspections indicating varying risks. This implies that WHO prescribed inspections yield higher risks, and overestimated risk perception are likely to skew planning and policy, resulting in budgetary over-allocations and financial mismanagement in water-supplies. There is thus an urgent need to review and revise WHO prescribed sanitary inspection templates.

Personal protective equipment for ENT activity during COVID-19 pandemic.

BACKGROUND: In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. METHODS: A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. RESULTS: Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. CONCLUSION: A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.

Endoscopic nasopharyngoscopy and ENT specialist safety in the COVID 19 era: the back endoscopy approach to the patient.

PURPOSE: To propose a way to safely perform endoscopic nasopharyngoscopy in ENT outpatient clinic during the COVID-19 pandemic. METHODS: This manuscript highlights the importance of endoscopy in daily ENT clinical practice, which is a pivotal procedure in the diagnosis of many head and neck pathologies. However, since the beginning of the COVID-19 outbreak, the authors have witnessed a drastic reduction (91%) in the use of endoscopic nasopharyngoscopy at their institutions. In fact, it is considered at risk of contamination for healthcare professionals, as any upper airway manipulation procedure. RESULTS: In the "Back approach to the patient" for endoscopic nasopharyngoscopy, the operator positions himself behind the patient and faces the monitor. The endoscopist, not being positioned in front of the patient, should, therefore, be less exposed to airborne transmission of SARS-CoV-2 virus. CONCLUSION: This simple variation of the physician's position during endoscopic nasopharyngoscopy could potentially reduce the risk of contagion since the operator is not in the trajectory of droplets and/or aerosols.

Performing the nasopharyngeal and oropharyngeal swab for 2019-novel coronavirus (SARS-CoV-2) safely: How to dress, undress, and technical notes.

BACKGROUND: To show how to safely perform nasopharyngeal and/or oropharyngeal swabs for 2019-novel coronavirus. METHODS: The video describes in detail the dressing and undressing procedures of health personnel, with the appropriate personal protective equipment. Technical notes for the execution of the nasopharyngeal and oropharyngeal swab are also provided to avoid sampling errors. RESULTS: The undressing phase is the procedure with the highest risk of self-contamination for the health worker. Following the various steps as shown in the video, there were no cases of contagion among the otolaryngology team appointed to perform the swabs for SARS-CoV-2 testing. CONCLUSIONS: This study demonstrates the technical feasibility of safely performing nasopharyngeal and/or oropharyngeal swabs for identification of SARS-CoV-2 viral RNA.

COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice.

The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

On the prevalence of gunshot residue in selected populations - an empirical study performed with SEM-EDX analysis.

The study was designed to obtain a comprehensive view on the prevalence of gunshot residue and the factors influencing their dispersion. 273 specimens collected from people of various professions, representing both users and non-users of firearms, as well as from the interior of a forensic laboratory were examined for the presence of gunshot residue. In specimens taken from hands of 100 people declaring no contact with firearms only one spherical particle containing lead, antimony and barium was found. Numbers of particles found in specimens collected from hands of 50 shooters varied from zero to numbers greater than 100 and were strongly correlated with the time interval between last shooting and collecting specimens. Within the first 4h after shooting particles are being lost from the shooter's hands, and so transferred from shooters to their environment. Thus, the relatives of five hunters were examined during both the close and open hunting seasons to trace the potential secondary transfer in practice. Using the criterion of low risk of contamination with gunshot residue, i.e. 5h after last handling a gun, only few specimens were encountered among these collected from hands of firearm users that contained characteristic particles and these occurred in small numbers. Frequent shooters, e.g. shooting instructors or firearm examiners, formed a class for themselves of high risk of contamination with gunshot residue. As a result of continuous monitoring of the laboratory (55 specimens examined so far), where the examinations of gunshot residue are being carried out, it has been proved that the laboratory is free from contamination and so confirmed the usefulness of protocols worked out. The obtained information provided empirical bases to the minimisation of the risk of contamination of the evidence as well as for the evaluation of the analytical findings in the expertise on gunshot incidents.

Foot-operated door opener to eliminate the door handle as a source of contamination.

AIM: As door handles represent a transmission route for viruses and micro-organisms, a door opening and closing mechanism should be developed without manual operation. METHOD: To solve the problem, a device for opening the door with the help of a foot pedal was built into the door leaf. RESULTS: The design enables mechanical opening of the door with a foot pedal without manual operation. Subsequently, the door closes with the help of a mechanical locking mechanism. DISCUSSION: The foot-operated door opener constitutes an additional option to the door handle. Together with the equipment of a soft closing mechanism, it is possible to prevent noise emanating from the door latch impinging on the door frame. Using this construction, the door handle as a transmission vector is eliminated. In addition, the transport of goods held with two hands simultaneously is facilitated. CONCLUSION: With a foot-operated door opener instead of the traditional manual door handle, it is possible to open doors with a foot pedal. This prevents contamination of door handles with pathogens.