Towards interoperability in infection control: a standard data model for microbiology.

The COVID-19 pandemic has made it clear: sharing and exchanging data among research institutions is crucial in order to efficiently respond to global health threats. This can be facilitated by defining health data models based on interoperability standards. In Germany, a national effort is in progress to create common data models using international healthcare IT standards. In this context, collaborative work on a data set module for microbiology is of particular importance as the WHO has declared antimicrobial resistance one of the top global public health threats that humanity is facing. In this article, we describe how we developed a common model for microbiology data in an interdisciplinary collaborative effort and how we make use of the standard HL7 FHIR and terminologies such as SNOMED CT or LOINC to ensure syntactic and semantic interoperability. The use of international healthcare standards qualifies our data model to be adopted beyond the environment where it was first developed and used at an international level.

Dispersion of sneeze droplets in a meat facility indoor environment - Without partitions.

Spreading patterns of the coronavirus disease (COVID-19) showed that infected and asymptotic carriers both played critical role in escalating transmission of virus leading to global pandemic. Indoor environments of restaurants, classrooms, hospitals, offices, large assemblies, and industrial installations are susceptible to virus outbreak. Industrial facilities such as fabrication rooms of meat processing plants, which are laden with moisture and fat in indoor air are the most sensitive spaces. Fabrication room workers standing next to each other are exposed to the risk of long-range viral droplets transmission within the facility. An asymptomatic carrier may transmit the virus unintentionally to fellow workers through sporadic sneezing leading to community spread. A novel Computational Fluid Dynamics (CFD) model of a fabrication room with typical interior (stationary objects) was prepared and investigated. Study was conducted to identify indoor airflow patterns, droplets spreading patterns, leading droplets removal mechanism, locations causing maximum spread of droplets, and infection index for workers along with stationary objects in reference to seven sneeze locations covering the entire room. The role of condensers, exhaust fans and leakage of indoor air through large and small openings to other rooms was investigated. This comprehensive study presents flow scenarios in the facility and helps identify locations that are potentially at lower or higher risk for exposure to COVID-19. The results presented in this study are suitable for future engineering analyses aimed at redesigning public spaces and common areas to minimize the spread of aerosols and droplets that may contain pathogens.

Two cases of COVID-19 presenting with severe malaria: a clinical challenge (case report).

The novel coronavirus (COVID-19) pandemic has stretched the medical resources of both developed and developing countries. The global focus on COVID-19 may lead to the neglect of other infectious diseases such as malaria which is still endemic in many African countries. Some similarities in malaria and COVID-19 disease presentations may also lead to late diagnosis of either disease which could complicate the effects. Here, we present two cases of a 6-year-old child and a 17-year-old female who presented to a primary care facility in Ghana with a clinical and microscopy-confirmed diagnosis of severe malaria complicated by thrombocytopenia. As their symptoms worsened with associated respiratory complications, nasopharyngeal samples were taken for real-time polymerase chain reaction (RT-PCR) and tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinicians, policymakers, and public health practitioners should be alert to the variety of presenting symptoms of COVID-19 and its similarity to malaria to mitigate the risk of mortality from either disease.

Techno-Economic and life cycle assessment of standalone Single-Stream material recovery facilities in the United states.

Material Recovery Facilities (MRFs) are crucial players in achieving a circular economy. MRFs receive complex waste streams and separate valuable recyclables from these mixtures. This study conducts techno-economic analysis (TEA) to estimate the net present value (NPV) and life cycle assessment (LCA) to estimate different environmental impacts of a commercial scale standalone, single-stream MRF to assess the economic feasibility and environmental impacts of recovering valuable recyclables from an MRF processing 120,000 tonnes per year (t/y). The TEA employs a discounted cash flow rate of return (DCFROR) analysis over a 20-year facility lifetime, along with a sensitivity analysis on the impact of different operating and economic parameters. Results show that the total fixed cost of building the MRF facility is $23 MM, and the operating cost is $45.48/tonne. The NPV of the MRF can vary from $3.57 MM to $60 MM, while 100-year global warming potential can range from 5.98 to 8.53 kg carbon dioxide equivalents (CO2-eq) per tonne of MSW. We have also found that MSW composition (arising from regional effects) significantly impacts costs, 100-year global warming potential, and other impact categories such as acidification potential, eutrophication potential, ecotoxicity, ozone depletion, photochemical oxidation, carcinogenic effects, and non-carcinogenic effects. Sensitivity and uncertainty analysis indicate that waste composition and market prices significantly impact the profitability of the MRF, and the waste composition mostly impacts global warming potential. Our analysis also indicates that facility capacity, fixed capital cost, and waste tipping fees are vital parameters that affect the economic viability of MRF operations.

The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless."

BACKGROUND: Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. METHODS: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. RESULTS: There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. CONCLUSIONS: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.

Confronting 'chaos': a qualitative study assessing public health officials' perceptions of the factors affecting Tanzania's COVID-19 vaccine rollout.

OBJECTIVES: Mass COVID-19 vaccination in Africa is required to end the pandemic. In low-income settings, street-level bureaucrats (SLBs), or public officials who interact directly with citizens, are typically responsible for carrying out vaccination plans and earning community confidence in vaccines. The study interviewed SLBs to assess their perceptions of the factors affecting COVID-19 vaccination rollout in Tanzania. METHODS: We interviewed 50 SLBs (19 rural; 31 urban) responsible for implementing COVID-19 vaccination microplans across four diverse regions and districts of Tanzania in September 2021. Moreover, we conducted six in-depth interviews with non-governmental organisation representatives and seven focus group discussions with health facility governing committees. We asked for their perceptions of factors facilitating and challenging vaccine rollout according to three preidentified domains: political, health system and community. We analysed translated transcripts using a thematic analysis approach. RESULTS: Political factors facilitating mass vaccination included the executive leadership change from a denialist president to a president who accepted vaccines and promoted transparency. Global integration, commercially and politically, also motivated vaccine acceptance. Political challenges included community confusion that emerged from the consecutive presidents' divergent communications and messaging by prominent religious antivaccination leaders. Health system factors facilitating vaccination included scaling up of immunisation sites and campaigns. Urban district officials reported greater access to vaccination sites, compared with rural officials. Limited financial resources for paying healthcare workers and for transport fuel and a lack of COVID-19 testing compromised mass vaccination. Furthermore, SLBs reported being inadequately trained on COVID-19 vaccine benefits and side effects. Having community sources of accurate information was critical to mass vaccination. Challenges at the community level included patriarchal gender dynamics, low risk perception, disinformation that the vaccine has satanic elements, and lack of trust in coronavirus vaccines. CONCLUSION: Mass COVID-19 vaccination in Tanzania will require greater resources and investment in training SLBs to mitigate mistrust, overcome misinformation, and engage communities.

Preparing a deployed role 3 medical treatment facility for COVID-19 in Afghanistan.

The Craig Joint Theater Hospital at Bagram Airfield is the coalition role 3 facility for the North Atlantic Treaty Organization-led Operation RESOLUTE SUPPORT in northern Afghanistan. The onset of the global COVID-19 pandemic in early 2020 presented the challenges of limiting viral transmission, disease force protection, specific protection of healthcare workers and management of patients with COVID-19, all while continuing to provide high-quality care for battlefield trauma. The estimated COVID-19 threat led to the introduction of enhanced force protection measures across the Combined Joint Operations Area-Afghanistan. Surveillance testing of high-risk groups at coalition locations was established. Non-essential movements were restricted and quarantine periods instigated. Protection of healthcare workers and patients was improved with enhanced personal protective equipment as well as structural, procedural and personnel changes across the role 3 facility in order to limit viral exposure and transmission. This occurred in a resource-limited environment without degrading overall clinical capability.

Which countries need COVID-19 vaccines the most? Development of a prioritisation tool.

BACKGROUND: The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) have affected all countries. With a scarcity of COVID-19 vaccines there has been a need to prioritize populations, but assessing relative needs has been challenging. The COVAX Facility allocates vaccines to cover 20% of each national population, followed by a needs assessment that considers five quantitative metrics alongside a qualitative assessment. The objective of this study was to identify the most important factors for assessing countries' needs for vaccines, and to weight each, generating a scoring tool for prioritising countries. METHODS: The study was conducted between March and November 2021. The first stage involved an online Delphi survey with a purposive and snowball sample of public health experts, to reach consensus on country-level factors for assessing relative needs for COVID-19 vaccines. The second stage involved a discrete choice experiment (DCE) to determine weights for the most important factors. RESULTS: Responses were received from 28 experts working across 13 different countries and globally. The most common job titles reported were director and professor, with most based in national public health institutes (n = 9) and universities (n = 8). The Delphi survey found 37 distinct factors related to needs. Nine of the most important factors were included in the DCE. Among these, the most important factor was the 'proportion of overall population not fully vaccinated' (with a mean weight of 19.5), followed by 'proportion of high-risk population not fully vaccinated' (16.1), 'health system capacity' (14.2), 'capacity to purchase vaccines' (11.9) and the 'proportion of the population clinically vulnerable' (11.3). CONCLUSIONS: Several factors exist, extending beyond those currently used, which may lead to some countries having a greater need for vaccines compared to others. By assessing relative needs, this scoring tool can build on existing methods to further the role of equity in global COVID-19 vaccine allocation.

Life cycle assessment of a wind farm in Turkey.

The aim of this study is to investigate the environmental impacts of a full-scale wind farm using life cycle assessment methodology. The facility in question is an onshore wind farm located in Turkey with a total installed capacity of 47.5 MW consisting of 2.5 MW Nordex wind turbines. Hub height and rotor diameter of the wind turbines are 100 m. The system boundary is defined as material extraction, part production, construction, operation and maintenance and decommissioning phases of the wind farm. The functional unit is 1-kWh electricity produced. Environmental impacts are mainly generated by manufacturing and installation operations. Steel sheet usage in tower manufacturing is the main contributor to abiotic depletion of fossil resources, acidification, eutrophication, global warming and marine aquatic ecotoxicity potentials. Apart from ozone layer depletion, end-of-life phase decreases the environmental impacts due to metal recycling. Metal recycling ratio scenario results show that when the recycling ratio decreases from 90 to 20%; increases of 110%, 102%, 92% and 87% are observed in acidification, terrestrial ecotoxicity, marine aquatic ecotoxicity and global warming potentials, respectively. In the baseline, the main parts which are manufactured in Germany are transported by sea to Turkey. Transportation scenario involves shifting the manufacturing of main parts to Turkey then transporting these parts by trucks to the farm. This conversion causes increases of 31%, 35% and 27% in abiotic depletion of fossil resources, freshwater aquatic ecotoxicity and global warming potentials, respectively, while causing decreases of 11% and 4% in acidification and eutrophication potentials generated by transportation activities, respectively.

Wood Vault: remove atmospheric CO2 with trees, store wood for carbon sequestration for now and as biomass, bioenergy and carbon reserve for the future.

BACKGROUND: Wood harvesting and storage (WHS) is a hybrid Nature-Engineering combination method to combat climate change by harvesting wood sustainably and storing it semi-permanently for carbon sequestration. To date, the technology has only been purposefully tested in small-scale demonstration projects. This study aims to develop a concrete way to carry out WHS at large-scale. RESULTS: We describe a method of constructing a wood storage facility, named Wood Vault, that can bury woody biomass on a mega-tonne scale in specially engineered enclosures to ensure anaerobic environments, thus preventing wood decay. The buried wood enters a quasi-geological reservoir that is expected to stay intact semi-permanently. Storing wood in many environments is possible, leading to seven versions of Wood Vault: (1) Burial Mound (Tumulus or Barrow), (2) Underground (Pit, Quarry, or Mine), (3) Super Vault, (4) Shelter, (5) AquaOpen or AquaVault with wood submerged under water, (6) DesertOpen or DesertVault in dry regions, (7) FreezeVault in cold regions such as Antarctica. Smaller sizes are also possible, named Baby Vault. A prototype Wood Vault Unit (WVU) occupies 1 hectare (ha, 100 m by 100 m) of surface land, 20 m tall, stores up to 100,000 m3 of wood, sequestering 0.1 MtCO2. A 1 MtCO2 y-1 sequestration rate can be achieved by collecting currently unused wood residuals (WR) on an area of 25,000 km2, the size of 10 typical counties in the eastern US, corresponding to an average transportation distance of less than 100 km. After 30 years of operation, such a Wood Vault facility would have sequestered 30 MtCO2, stored in 300 WVUs, occupying a land surface of 300 ha. The cost is estimated at $10-50/tCO2 with a mid-point price of $30/tCO2. To sequester 1 GtCO2 y-1, wood can be sourced from currently unexploited wood residuals on an area of 9 Mkm2 forested land (9 million square kilometers, size of the US), corresponding to a low areal harvesting intensity of 1.1 tCO2 ha-1 y-1. Alternatively, giga-tonne scale carbon removal can be achieved by harvesting wood at a medium harvesting intensity of 4 tCO2 ha-1 y-1 on 3 Mkm2 of forest (equivalent to increasing current world wood harvest rate by 25%), or harvest on 0.8 Mkm2 forest restored from past Amazon deforestation at high harvest intensity, or many combinations of these and other possibilities. It takes 1000 facilities as discussed above to store 1 GtCO2 y-1, compared to more than 6000 landfills currently in operation in the US. After full closure of a Wood Vault, the land can be utilized for recreation, agriculture, solar farm, or agrivoltaics. A more distributed small operator model (Baby Vault) has somewhat different operation and economic constraints. A 10 giga-tonne sequestration rate siphons off only 5% of total terrestrial net primary production, thus possible with WHS, but extreme caution needs to be taken to ensure sustainable wood sourcing. CONCLUSIONS: Our technical and economic analysis shows that Wood Vault can be a powerful tool to sequester carbon reliably, using a variety of wood sources. Most pieces of the technology already exist, but they need to be put together efficiently in practice. Some uncertainties need to be addressed, including how durability of buried wood depends on detailed storage methods and burial environment, but the science and technology are known well enough to believe the practicality of the method. The high durability, verifiability and low-cost makes it already an attractive option in the current global carbon market. Woody biomass stored in Wood Vaults is not only a carbon sink to combat current climate crisis, but also a valuable resource for the future that can be used as biomass/bioenergy and carbon supply. The quantity of this wood utilization can be controlled carefully to maintain a desired amount of CO2 in the atmosphere to keep the Earth's climate from diving into the next ice age, acting as a climate thermostat. The CO2 drawdown time is on the order of 100 years while the ramp-up time is a decade. A sense of urgency is warranted because the CO2 removal rate is limited by biosphere productivity, thus delayed action means a loss of opportunity. In conclusion, WHS provides a tool for managing our Earth system, which will likely remain forever in the Anthropocene.

Environmental radiation and health risk assessment in the neighborhood of a radioactive waste management facility.

The Radioactive Waste Management Center (RWMC) of the Ghana Atomic Energy Commission (GAEC) operates a licensed radioactive waste management facility known as the Centralized Radioactive Waste Management Facility (CRWMF). The Center undertakes environmental radiation monitoring in which indoor dose rates at various microenvironments, and nearby ambient environments of the facility are measured. A 2-year radiation dose data (i.e., 2017 and 2018) obtained from the monitoring exercise was used to determine whole-body exposure and cancer risk analysis for adult and child age groups. With the exception of the high dose area of the facility, observed doses in all microenvironments of the facility as well as the ambient environment were below the regulatory dose limits of 1 mSv/y and 20 mSv/y, set for radiation workers and the general public, respectively. Dose rate variation for the 2017 and 2018 datasets were not significant (p > 0.05) at 95% confidence interval (CI). Cancer risks due to exposure to alpha, neutron, and gamma radiation sources for both adult and child age groups were above the global average value of 2.90 × 10-4 reported by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Gamma sources recorded the highest cancer risk followed by neutron and alpha sources with risk values of 3.95 × 10-1 and 3.92 × 10-2; 4.06 × 10-2 and 4.03 × 10-3; and 7.96 × 10-4 and 7.91 × 10-5 for the adult and child age groups, respectively. Radium (226Ra) recorded the highest activity concentration (9.62 × 1010 Bq) with 4 quantities in the inventory while plutonium-beryllium (as alloyed source) recorded the lowest activity concentration (9.82 × 1001) with 12 quantities in the inventory.

Application of ArcGIS and QFD-based model for site selection for bio-medical waste disposal.

With the increasing formalisation of the health sector in India, the bio-medical waste (BMW) disposal regulations are getting stringent and its implementation is being enforced strictly. The coronavirus disease 2019 (COVID-19) created a healthcare crisis because of the highly contagious nature of the novel virus. Measures employed for the prevention and management of COVID-19 resulted in the generation of an unprecedented amount of BMW in Indian medical history. This BMW needs to be disposed of safely at a suitable site to prevent secondary infection and the potential spread of the virus in the environment. The selection of an appropriate site for BMW disposal requires comparing a wide range of social, economic and environmental factors corresponding to different site locations, which makes it a multi-criteria decision-making (MCDM) problem. This study aims to solve the BMW site selection problems using a quality function deployment-based model that can consider both the subjective and the objective criteria, and evaluate them as per the user's requirements. The proposed model is applied to evaluate the suitability of waste disposal sites in the city of Bilaspur in Chhattisgarh, India. At first, eight possible locations for BMW disposal are identified, while utilising geographical information system (GIS). Consequently, the developed model is applied to evaluate the identified sites, taking 18 relevant criteria into consideration. A software prototype is developed in Visual BASIC 6 to automate the entire decision-making process, further adding to the novelty of the work.

Occurrence of Pharmaceutically Active Compounds and Potential Ecological Risks in Wastewater from Hospitals and Receiving Waters in Sri Lanka.

The presence of pharmaceutically active compounds (PACs) in the environment and their associated hazards is a major global health concern; however, data on these compounds are scarce in developing nations. In the present study, the existence of 39 non-antimicrobial PACs and six of their metabolites in wastewater from hospitals and adjacent surface waters in Sri Lanka was investigated from 2016 to 2018. The highest amounts of the measured chemicals, including the highest concentrations of atorvastatin (14,620 ng/L) and two metabolites, mefenamic acid (12,120 ng/L) and o-desmethyl tramadol (8700 ng/L), were detected in wastewater from the largest facility. Mefenamic acid, gemfibrozil, losartan, cetirizine, carbamazepine, and phenytoin were detected in all the samples. The removal rates in wastewater treatment were 100% for zolpidem, norsertaline, quetiapine, chlorpromazine, and alprazolam. There was substantial variation in removal rates of PACs among facilities, and the overall data suggest that treatment processes in facilities were ineffective and that some PAC concentrations in the effluents were increased. The estimated risk quotients revealed that 14 PACs detected in water samples could pose low to high ecological risk to various aquatic organisms. Compounds such as ibuprofen, tramadol, and chlorpromazine detected in untreated and treated wastewater at these facilities pose a high risk to several aquatic organisms. Our study provides novel monitoring data for non-antimicrobial PAC abundance and the associated potential ecological risk related to hospitals and urban surface waters in Sri Lanka and further offers valuable information on pre-COVID-19 era PAC distribution in the country. Environ Toxicol Chem 2022;41:298-311. © 2021 SETAC.

New insight on occurrence of liquid crystal monomers: A class of emerging e-waste pollutants in municipal landfill leachate.

Liquid crystal monomers (LCMs) have been proposed as a class of emerging organic pollutants, which were recently detected in indoor dust and sediment samples collected near electronic devices recycling facilities. However, there is a knowledge gap for analytical method, occurrence, and distribution of LCMs in aqueous sample. Herein, a robust method was developed to determine 38 target LCMs in landfill leachate. A combined ultrasonic enhanced liquid-liquid extraction, saponification and silica/florisil packed column purification method achieved recoveries of 76.9~127.1%, 84.5~114.6% and 81.3~104.6% at spiking levels of 2 ng, 10 ng and 50 ng in leachate, respectively. The developed method was validated through determination of target LCMs in leachate samples collected from municipal landfills in Hong Kong (HK) and Shenzhen (SZ), China. There were 23 and 20 LCMs detected in the HK (ΣLCMs=1120 ng/L) and SZ (ΣLCMs=409 ng/L) sample, respectively, with 6 LCMs newly detected in the environment. This study provided the first evidence suggesting that landfill leachate might be a potential sink of LCMs emitted from e-waste. Future study is urged to investigate the potential migration of LCMs from landfill leachate as a point source, and their occurrence, distribution, fate, and ecotoxicological risk in aquatic environments on regional and global scales.

At-home testing to mitigate community transmission of SARS-CoV-2: protocol for a public health intervention with a nested prospective cohort study.

BACKGROUND: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve as a global health crisis. Although highly effective vaccines have been developed, non-pharmaceutical interventions remain critical to controlling disease transmission. One such intervention-rapid, at-home antigen self-testing-can ease the burden associated with facility-based testing programs and improve testing access in high-risk communities. However, its impact on SARS-CoV-2 community transmission has yet to be definitively evaluated, and the socio-behavioral aspects of testing in underserved populations remain unknown. METHODS: As part of the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program funded by the National Institutes of Health, we are implementing a public health intervention titled "Say Yes! COVID Test" (SYCT) involving at-home self-testing using a SARS-CoV-2 rapid antigen assay in North Carolina (Greenville, Pitt County) and Tennessee (Chattanooga City, Hamilton County). The intervention is supported by a multifaceted communication and community engagement strategy to ensure widespread awareness and uptake, particularly in marginalized communities. Participants receive test kits either through online orders or via local community distribution partners. To assess the impact of this intervention on SARS-CoV-2 transmission, we will conduct a non-randomized, ecological study using community-level outcomes. Specifically, we will evaluate trends in SARS-CoV-2 cases and hospitalizations, SARS-CoV-2 viral load in wastewater, and population mobility in each community before, during, and after the SYCT intervention. Individuals who choose to participate in SYCT will also have the option to enroll in an embedded prospective cohort substudy gathering participant-level data to evaluate behavioral determinants of at-home self-testing and socio-behavioral mechanisms of SARS-CoV-2 community transmission. DISCUSSION: This is the first large-scale, public health intervention implementing rapid, at-home SARS-CoV-2 self-testing in the United States. The program consists of a novel combination of an at-home testing program, a broad communications and community engagement strategy, an ecological study to assess impact, and a research substudy of the behavioral aspects of testing. The findings from the SYCT project will provide insights into innovative methods to mitigate viral transmission, advance the science of public health communications and community engagement, and evaluate emerging, novel assessments of community transmission of disease.

Application of ISO/IEC Guide 51 to COVID-19 infection control for the occupational safety.

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.

COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis.

Workplaces can be high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. The included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, environmental adjustments, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-one studies from healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ~280,000 employees based in Europe, Asia, and North America. Meta-analyses showed that combined IPC measures resulted in lower employee COVID-19 positivity rates (0.2% positivity; 95% CI 0-0.4%) than single measures such as asymptomatic PCR testing (1.7%; 95% CI 0.9-2.9%) and universal masking (24%; 95% CI 3.4-55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning can effectively prevent workplace outbreaks. Masking alone should not be considered sufficient protection from SARS-CoV-2 outbreaks in the workplace.

Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic.

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.

Food Safety and Employee Health Implications of COVID-19: A Review.

The COVID-19 pandemic has greatly impacted the U.S. food supply and consumer behavior. Food production and processing are being disrupted as illnesses, proactive quarantines, and government-mandated movement restrictions cause labor shortages. In this environment, the food industry has been required to adopt new, additional practices to minimize the risk of COVID-19 cases and outbreaks among its workforce. Successfully overcoming these challenges requires a comprehensive approach that addresses COVID-19 transmission both within and outside the facility. Possible interventions include strategies (i) to vaccinate employees, (ii) to assure that employees practice social distancing, (iii) to assure that employees wear face coverings, (iv) to screen employees for COVID-19, (v) to assure that employees practice frequent hand washing and avoid touching their faces, (vi) to clean frequently touched surfaces, and (vii) to assure proper ventilation. Compliance with these control strategies must be verified, and an overall COVID-19 control culture must be established to implement an effective program. Despite some public misperceptions about the health risk of severe acute respiratory syndrome coronavirus 2 on foods or food packaging, both the virus biology and epidemiological data clearly support a negligible risk of COVID-19 transmission through food and food packing. However, COVID-19 pandemic-related supply chain and workforce disruptions and the shift in resources to protect food industry employees from COVID-19 may increase the actual food safety risks. The goal of this review was to describe the COVID-19 mitigation practices adopted by the food industry and the potential impact of these practices and COVID-19-related disruptions on the industry's food safety mission. A review of these impacts is necessary to ensure that the food industry is prepared to maintain a safe and nutritious food supply in the face of future global disruptions.

SARS Cov2 outbreak management on a landing helicopter dock: An observational retrospective study.

OBJECTIVES: Even though SARS Cov2 outbreak management has been well-described, scant information is available in military settings. We aimed to describe a SARS Cov2 outbreak and its management on the Dixmude, a French landing helicopter dock. PATIENTS AND METHODS: We performed an observational retrospective and monocentric study in a ship. Role 1 was reinforced by additional roles 1 and 2. Our analysis included all infected crew personnel. We described demographic data, outbreak course, and biological samples including Covid-19 diagnosis. All infected patients were monitored for 10 days. RESULTS: Between February 16th 2021 and March 12th 2021, 54 patients (10% of the entire crew) were included. No patient had previously been vaccinated against SARS Cov2. The global mission was maintained. The crew members were healthy, male, and young (median age 28 years) with no medical history. Ranks of every status were concerned. Covid-19 disease was mainly diagnosed by real-time reverse-transcriptase polymerase chain reaction (rt-PCR). Thirty-two patients (59%) were symptomatic, four (8%) were presymptomatic and 18 (33%) remained asymptomatic. CONCLUSIONS: The present work describes specific SARS Cov2 outbreak management in an austere military environment. Early individual and global measures were set and implemented on board.