新型冠状病毒肺炎疫情中医护人员个人防护装备的选择与使用

个人防护设备(personal protective equipment,PPE)是控制院内感染的必要装备,可有效降低医护人员职业暴露的风险。 目前,新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情引起国际高度关注,国内已确诊7万多例患者,死亡人数超过 2 700 人。此外,医护人员的感染超过 3 000 多例,这给医护人员(尤其是为COVID-19患者提供近距离诊疗和护理的医务人员),带来了新的风险和挑战。 本文从PPE的应用标准,正确穿、脱方法及预防防护后暴露的注意事项进行汇总和讨论。     

生物安全三级实验室2种防护型口罩的定量适合性测试比较

目的:对2种防护型口罩(3M1860杯状、3M9332折叠型)进行定量适合性检测,为实验人员合理选择防护型口罩提供依据。方法:使用Model8038型口罩定量适合性检测仪,检测68名实验人员对这2种防护型口罩的适合性,并对每种防护型口罩在检测时规定动作的适合性因子数进行统计学分析。结果:68名测试人员中,有49人通过3M1860适合性检验,41人通过3M9332适合性检验。在不同及相同动作下,规定动作对2种防护型口罩适合性通过率均无差异(P0.05)。对2种防护型口罩的68次适合性检测的规定动作进行适合性因子分析,发现3M1860杯状口罩除深呼吸(P=0.567)对其初次佩戴口罩适合性的影响无差异外,其他动作(左右转头、低头抬头、说话、弯腰)均对其适合性影响有差异(P0.050);3M9332折叠型口罩,说话(P=0.000)及弯腰(P=0.000)对初次佩戴口罩适合性的影响有差异,其他动作(深呼吸、左右转头、低头抬头)对其适合性影响无差异。结论:在口罩定量适合性检测通过的情况下,根据每一项动作的适合性因子数,选择适合自己实验活动的防护型口罩,提高口罩的防护效果,保障实验人员的安全。     

安全、便捷技术再生一次性医用口罩的实验研究

在防控新型冠状病毒(2019 novel coronavirus, 2019-nCoV)疫情中,为了减少病毒的传播,一次性医用口罩是普通民众必不可缺少的防护品。然而,随着2019-nCoV的蔓延,口罩短缺现象严重。本研究旨在探讨一次性医用外科口罩(口罩)的再生方法,以达到既有个人防护的效果又能节省资源。用流行性感冒病毒(简称流感)模拟2019-nCoV污染口罩,采用常用的恒温烘箱干烤及电吹风机热风处理2种方法,对表面污染有流感病毒的医用口罩进行病毒灭活,洗脱口罩上已灭活处理的病毒,感染Mardin-Darby狗肾细胞(Mardin-Darby canine kidney cell,MDCK细胞),观察细胞病变并定量检测病毒基因组拷贝数以评价病毒灭活效果。同时采用抽滤系统和PM2.5监测仪对以2种相似热灭活方式处理过的口罩滤过截留PM2.5的效果进行评价。结果显示电吹风机30 min热风处理后病毒基因组拷贝数降低至原来的1/1 000 000～1/10 000 000,接近未感染组,但烘箱56 ℃ 30 min干热处理仅灭活部分病毒。2种热灭活方式对口罩的PM2.5滤过截留效果无显著影响。本研究提供了一个安全、便捷处理一次性医用外科口罩的方法,为个人防护用品口罩表面污染病毒的灭活及其再生利用提供了科学依据。然而,应注意的是在口罩匮乏的非常时期,普通人群可采用该简便技术再生口罩后再次使用,但该方法再生的口罩不适合密切接触患者的人群、医护人员及实验室工作人员使用。     

城市绿地暴露与人群健康效应研究

城市绿地是城市绿色基础设施和基于自然解决方案的主要载体,为人群提供了多种生态系统服务,关注人群健康和绿地布局的城市绿地暴露研究已经成为城市生态学、城市可持续发展等学科的前沿热点。目前国内外城市绿地暴露与人群健康研究仍处在兴起的初步发展状态,缺乏有效和公认的研究范式。尝试通过暴露科学的视角,研究城市绿地暴露及其人群健康效应的研究的热点领域:(1)从城市人群的绿地暴露特征来看,绿地暴露研究与现有旨在预防和减少环境污染暴露风险的传统环境健康研究的视角有显著不同,其目标是充分理解人群的绿地暴露特征及其产生健康效应的机制,鼓励和提高人群与绿地的有效和有益接触,服务于城市绿地和健康社区营造的科学规划和决策。(2)从城市绿地暴露的量化表征来看,现有的多种绿地暴露评价指标包括绿地可得性、绿地可及性和绿地可视性等多是表征了绿地的供给状况,并非直接的绿地暴露过程描述,未来可以结合城市人群的绿地暴露时空动态模式,参照总暴露数学方程来综合量化不同途径、访问周期、暴露时长等因素。(3)从城市绿地暴露的人群健康效应机制来看,现有绿地暴露的健康效应机制研究获得的通用理论性成果还不多,面临的挑战主要是:不同绿地健康效应研究采用的暴露特征指标不同,绿地暴露特征影响人群健康存在显著的尺度性,以及缺乏统一的绿地暴露健康效应调查方法。绿地在城市规划和建设中的作用尤其突出,但绿地的人群健康促进功能在我国城市规划和建设中还鲜有应用,作为城市生态学与环境风险、公共健康以及可持续发展的交叉前沿领域,相关成果将为指导健康导向的可持续城市/社区规划与建设提供直接的科学依据与理论支撑。     

医务人员艾滋病职业暴露危险因素评估与防护现况调查

医务人员艾滋病职业暴露是关系到公众及医务人员身体健康和生命安全的公共卫生问题。保护医务人员免受艾滋病职业暴露的威胁已日益成为艾滋病防治的关键,北京市东城区疾病控制中心率先在北京市医务人员中开展艾滋病执业暴露危险因素及防护现状的调查,旨在了解和掌握医务人员艾滋病职业暴露危险因素及防护现况,为医务人员艾滋病职业暴露防护对策提供科学依据。     

行为运作管理在医院血源性暴露防护中的应用

目的 探讨医务人员血源性职业暴露防护干预模式,降低职业暴露发生率。方法 分析影响医务人员血源性职业暴露防护行为的因素,从行为运作视角构建“人—机—环境”的防护干预模式,在4所医院应用并评价干预效果。结果 干预后的医务人员防护知识、防护态度、防护行为及医院科室安全环境得分高于干预前,锐器伤发生率从51.5%下降至40.4%（P＜0.05）。结论 该模式的应用能有效提高医务人员安全防护知识,转变防护态度,促进安全行为依从性,降低血源性职业暴露发生率。

     

基于暴露分析与关键控制点方法对医院开展严重急性呼吸综合征冠状病毒2型检测的可行性研究

评估2019新型冠状病毒病暴发期间在医院开展严重急性呼吸综合征冠状病毒 2 型(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)核酸检测的可行性,为最终在医院开展核酸检测提供参考。熟悉暴露分析和关键点控制(exposure analysis and critical control points,EACCP)工作框架的专业人员在基于医院现实条件下,对SARS-CoV-2检测过程中可能的感染暴露风险和途径进行梳理,建立整个检测流程,验证在配备有发热门诊的医院开展的可行性,并明确降低暴露风险的关键控制点。高风险是在发热门诊标本的采集和灭活处理,中风险是未灭活标本的储运,低风险是灭活标本的储运和检测。优化检验流程能降低检测过程中感染暴露风险,对于高风险的操作,可在生物安全二级实验室(发热门诊或移动采集点等)和相应的安全防护等级下进行操作; EACCP分析方法可用于新发感染性疾病暴发期间的管理。     

基于暴露分析与关键控制点方法对医院开展严重急性呼吸综合征冠状病毒2型检测的可行性研究（英文）

评估2019新型冠状病毒病暴发期间在医院开展严重急性呼吸综合征冠状病毒2型(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)核酸检测的可行性,为最终在医院开展核酸检测提供参考。熟悉暴露分析和关键点控制(exposure analysis and critical control points,EACCP)工作框架的专业人员在基于医院现实条件下,对SARS-CoV-2检测过程中可能的感染暴露风险和途径进行梳理,建立整个检测流程,验证在配备有发热门诊的医院开展的可行性,并明确降低暴露风险的关键控制点。高风险是在发热门诊标本的采集和灭活处理,中风险是未灭活标本的储运,低风险是灭活标本的储运和检测。优化检验流程能降低检测过程中感染暴露风险,对于高风险的操作,可在生物安全二级实验室(发热门诊或移动采集点等)和相应的安全防护等级下进行操作;EACCP分析方法可用于新发感染性疾病暴发期间的管理。     

综合性医院中呼吸道传染病医院感染的防控

呼吸道传染病疫情已成为突出的公共卫生问题,综合性医院在呼吸道传染病防控中起着至关重要的作用。在患者就诊过程中及时采取医院感染防控的各项措施,对控制疾病播散、保障患者就诊安全和医务人员职业安全具有重要意义。综合性医院呼吸道传染病的医院感染防控措施应包括：完善的规章制度、各部门联防联控、加强感染性疾病科的软硬件建设、重点人群的监测与管理、正确的消毒隔离措施、重视人员防护和手卫生、医疗废物的规范管理。     

股动脉假性动脉瘤形成并破裂出血的院前急救

目的 探讨股动脉假性动脉瘤形成并破裂出血的院前急救措施.方法 回顾性分析16例股动脉假性动脉瘤形成并破裂出血患者的院前救治,如现场加压包扎止血、快速补充血容量、安全转运、与院内急救无缝衔接及个人防护等.结果 16例患者均经静脉吸毒,其中明确HIV感染11例,除2例现场抢救无效死亡外,余14例均能有效止血,血压回升,及时、安全转送到外科病房,其中5例患者直接进行手术治疗,14例患者均好转出院;医务人员无职业暴露发生.结论 采取序贯有效的综合处置措施,是对股动脉假性动脉瘤并破裂出血患者院前急救成功的关键;熟练掌握院前急救止血等技术,注重个人职业暴露的防护,能降低职业暴露的风险,最大限度地保证医患双方安全.     

Professional and home-made face masks reduce exposure to respiratory infections among the general population

Background

Governments are preparing for a potential influenza pandemic. Therefore they need data to assess the possible impact of interventions. Face-masks worn by the general population could be an accessible and affordable intervention, if effective when worn under routine circumstances.

Methodology

We assessed transmission reduction potential provided by personal respirators, surgical masks and home-made masks when worn during a variety of activities by healthy volunteers and a simulated patient.

Principal Findings

All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than home-made masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers).

Conclusions/Significance

Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission.     

Evaluation on masks with exhaust valves and with exhaust holes from physiological and subjective responses

The purpose of this study was to compare the effects of wearing different kinds of masks on the ear canal temperature, heart rate, clothing microclimate, and subjective perception of discomfort. Ten subjects performed intermittent exercise on a treadmill while wearing the protective masks in a climatic chamber controlled at an air temperature of 25 degrees C and a relative humidity of 70%. Two types of mask-mask A, with exhaust valves and mask B, with exhaust holes-were used in the study. The results of this study indicated: (1) The subjects had a tendency toward lower maximum heart rate when wearing mask A than when wearing mask B. (2) Temperatures and absolute humidities (the outer surface of mask, the microclimate inside the mask, the chest wall skin and microclimate) of mask A were significantly lower than those of mask B. (3) The ear canal temperature increased significantly in mask B as compared to that in mask A. (4) The ear canal temperature showed significant augmentation along with increased temperature and humidity inside the mask microclimate. The mask microclimate temperature also affected significantly the chest microclimate temperature. (5) Mask A was rated significantly lower for perception of humidity, heat, breath resistance, tightness, unfitness, odor, fatigue, and offered less overall discomfort than mask B. (6) Subjective preference for mask A was higher. (7) The ratings of subjective overall discomfort showed significant augmentation along with increased wetness and fatigue. We discuss how the ventilation properties of masks A and B induce significantly different temperature and humidity in the microclimates of the masks and the heat loss of the body, which have profound influences on heart rate, thermal stress, and subjective perception of discomfort.     

Principles and practice for SARS-CoV-2 decontamination of N95 masks with UV-C

A mainstay of personal protective equipment during the coronavirus disease 2019 pandemic is the N95 filtering facepiece respirator. N95 respirators are commonly used to protect healthcare workers from respiratory pathogens, including the novel coronavirus severe acute respiratory syndrome coronavirus 2, and are increasingly employed by other frontline workers and the general public. Under routine circumstances, these masks are disposable, single-use items, but extended use and reuse practices have been broadly enacted to alleviate critical supply shortages during the coronavirus disease 2019 pandemic. Although extended-time single use presents a low risk of pathogen transfer, repeated donning and doffing of potentially contaminated masks presents increased risk of pathogen transfer. Therefore, efficient and safe decontamination methods for N95 masks are needed to reduce the risk of reuse and mitigate local supply shortages. Here, we review the available literature concerning use of germicidal ultraviolet-C (UV-C) light to decontaminate N95 masks. We propose a practical method for repeated point-of-use decontamination using commercially available UV-C cross-linker boxes from molecular biology laboratories to expose each side of the mask to 800–1200 mJ/cm² of UV-C. We measure the dose that penetrated to the interior of the respirators and model the potential germicidal action on coronaviruses. Our experimental results, in combination with modeled data, suggest that such a UV-C treatment cycle should induce a >3-log-order reduction in viral bioburden on the surface of the respirators and a 2-log-order reduction throughout the interior. We find that a dose 50-fold greater does not impair filtration or fit of 3M 8210 N95 masks, indicating that decontamination can be performed repeatedly. As such, UV-C germicidal irradiation is a practical strategy for small-scale point-of-use decontamination of N95s.     

Ventilatory responses of the horse to exercise: effect of gas collection systems

Experiments were undertaken to determine whether respiratory masks worn by horses exercising strenuously on a treadmill may interfere with normal gas exchange. Four collection systems, two flow-through systems and two incorporating one-way valve systems with subject-generated airflow were studied. Six horses performed standard treadmill exercise tests consisting of a 2-min warm up followed by galloping 1 min each at 8,9, and 10 m/s. Each horse exercised six times while wearing each of the four respiratory masks. Each flow-through system was used twice with flow rates of 2,360 and 3,840 l/min for one system, and 3,840 and 6,300 l/min for the other. Arterial blood gas tensions were measured during exercise at each speed for each system and were compared with values measured when the horses performed the same test without wearing a mask. Hypercapnia developed during exercise with each of the respiratory masks except with the 6,300-l/min flow-through system. All horses became hypoxemic during every exercise test, but it was most severe when systems incorporating one-way valves were used. This, plus the degree of hypercapnia observed and a suboptimal heart rate-O2 uptake relationship, indicated that such systems severely impede ventilation and suggest that experiments performed while utilizing them do not represent the normal exercise condition.     

Can a combination of vaccination and face mask wearing contain the COVID-19 pandemic?

The COVID-19 pandemic is going into its third year with Europe again being the focus of major epidemic activity. The present review tries to answer the question whether one can come to grip with the pandemic by a combination of vaccinations and non-pharmaceutical interventions (NPIs). Several COVID-19 vaccines are of remarkable efficacy and achieve high protection rates against symptomatic disease, especially severe disease, but mathematical models suggest that the current vaccination coverage in many countries is insufficient to achieve pandemic control. NPIs are needed as complementary measures because recent research has also revealed the limits of vaccination alone. Here, we review the evidence for efficacy of face mask wearing in various settings. Overall pooled analysis showed significant reduction in COVID-19 incidence with mask wearing, although heterogeneity between studies was substantial. Controlled trials of mask wearing are difficult to conduct, separating mask wearing effects in population studies from the impact of other NPIs is challenging and the efficacy of masks depend on mask material and mask fit. The combination of vaccination and mask wearing is potentially synergistic since vaccination protects so far well from disease development (the omicron variant is currently an unknown) but immunity from infection wanes over few months after vaccination. In comparison, masks interfere with the virus transmission process at a level of a physical barrier independent of coronavirus variant. Vaccination and masks are much less costly to apply than other NPI measures which are associated with high economic and social costs, but paradoxically both measures are the target of a vocal opposition by a sizable minority of the society. In parallel with biomedical research, we need more social science research into this opposition to guide political decisions on how to end the pandemic.     

Assessment the protection performance of different level personal respiratory protection masks against viral aerosol

New viral disease such as SARS and H1N1 highlighted the vulnerability of healthcare workers to aerosol-transmitted viral infections. This paper was to assess the protection performance of different level personal respiratory protection equipments against viral aerosol. Surgical masks, N95 masks and N99 masks were purchased from the market. The masks were sealed onto the manikin in the aerosol testing chamber. Viral aerosol was generated and then sampled simultaneously before and after the tested mask using biosamplers. This allows a percentage efficiency value to be calculated against test phage SM702 aerosols which surrogates of viral pathogens aerosol. At the same time, the masks face fit factor was determined by TSI8020. The viral aerosol particles aerodynamic diameter was 0.744 μm, and GSD was 1.29. The protection performance of the material of all the tested masks against viral aerosol was all >95 %. All the five surgical masks face fit factor were <8. F model N95 mask and H model N99 mask face fit factor were all >160. G model N95 mask face fit factor was 8.2. The protection performances of N95 or N99 masks were many times higher than surgical mask when considering the face fit factor. Surgical masks cannot offer sufficient protection against the inhalation of viral aerosol because they cannot provide a close face seal.     

Respiratory symptoms in Manitoba farmers: association with grain and hay handling.

Of a random sample of farmers in two crop districts of Manitoba mailed a respiratory questionnaire in 1976, 833 (82% of those currently farming in the area) replied. More than half were grain farmers and nearly half had never smoked cigarettes. The prevalence of chronic cough and phlegm production, wheezing and exertional dyspnea was positively related to the amount of smoking but was also higher than expected in nonsmokers. Acute dyspnea, sometimes of delayed onset and accompanied by fever, was most commonly related to handling old grain and was reported by 44% of the farmers. Current smokers were more susceptible than nonsmokers to this type of dyspnea. Farmers with history of acute dyspnea while handling grain were more likely to wear masks, but the overall rate of mask wearing, even among those at highest risk, was low.     

Avian influenza risk perception and preventive behavior among traditional market workers and shoppers in Taiwan: practical implications for prevention

Background

Avian influenza (AI) can be highly pathogenic and fatal. Preventive behavior such as handwashing and wearing face masks has been recommended. However, little is known about what psychosocial factors might influence people''s decision to adopt such preventive behavior. This study aims to explore risk perception and other factors associated with handwashing and wearing face masks to prevent AI.

Methodology/Principal Findings

An interviewer-administered survey was conducted among 352 traditional market workers and shoppers in Taiwan between December 2009 and January 2010. Factors associated with the recommended AI preventive behavior (i.e., when in a traditional market, wearing a face mask and also washing hands after any contact with poultry) included: having correct knowledge about the fatality rate of AI (adjusted odds ratio [AOR] = 4.18), knowing of severe cases of AI (AOR = 2.13), being informed of local AI outbreaks (AOR = 2.24), living in northeastern Taiwan (AOR = 6.01), having a senior high-school education (AOR = 3.33), and having a university or higher education (AOR = 6.86). Gender interactive effect was also found among participants with a senior high-school education, with males being less likely to engage in the recommended AI preventive behavior than their female counterparts (AOR = 0.34).

Conclusions/Significance

Specific information concerning AI risk perception was associated with the recommended AI preventive behavior. In particular, having correct knowledge about the fatality rate of AI and being informed of severe cases and local outbreaks of AI were linked to increased AI preventive behavior. These findings underscore the importance of transparency in dealing with epidemic information. These results also have practical implications for prevention and policy-making to more effectively promote the recommended AI preventive behavior in the public.     

Occupational exposure to isoflurane during anaesthesia induction with standard and scavenging double masks in dogs, pigs and ponies

Induction of anaesthesia using a face mask may cause workplace pollution with anaesthetics. The aim of this study was to compare the effect of the use of a standard versus a scavenging double face mask on isoflurane pollution during induction of anaesthesia in experimental animals: six dogs, 12 pigs and five ponies. Pigs were anaesthetized only once using either mask type randomly (n = 6). Dogs and ponies were anaesthetized twice, using different mask types for each occasion in a random order with at least 14 days between experiments. The masks were attached to a Bain breathing system (dogs and pigs) or to a circle system (ponies) using a fresh gas flow of 300 or 50 mL/kg/min, respectively, with 5% vaporizer dial setting. Isoflurane concentrations were measured in the anaesthetist's breathing zone using an infrared photoacoustic spectrometer. The peak isoflurane concentrations (pollution) during baseline and induction periods were compared with Wilcoxon test in all species, and values between the mask types were compared with either Wilcoxon (ponies and dogs) or Mann-Whitney tests (pigs) (P < 0.05). Pollution was higher during induction when compared with baseline regardless of the mask type used but it was only statistically significant in dogs and pigs. Pollution was lower during induction with double versus single masks but it was only significant in pigs. Despite the lack of statistical significance, large and consistent differences were noted in all species, hence using scavenging masks is recommended to reduce isoflurane workplace pollution.     

Occupational exposure and respiratory health of workers at small scale industries

Certain occupations like welding, painting, and vehicle repairing are associated with regular exposure to dust, exhausts, fuels, fumes, PM, and vapors of welding, solvents, and paint. Many studies have proved a reduction in lung functions due to exposure to these agents. The present study aims to assess and compare respiratory symptoms and pulmonary functions among exposed and non-exposed persons as well as suggests controls respectively. A cross-sectional case study was carried out among small scale industry workers having matched demographic and anthropometric parameters. Medical Research Council (MRC) questionnaire and Micro Direct computerized automated spirometer were used for recording respiratory ailments and pulmonary function tests (PFT) respectively. The percentages of mechanics, welders and painters were 40.9, 31.8, and 27.3 respectively. The highest reported respiratory symptom was chest tightness and whistling among exposed (22.7%) and unexposed (10%). Among study exposed cases, the occupational exposure was found as often (22.7%), sometimes (68.2%) and never (9.1%) while the reported use of airway protection (masks) was very low. Overall respiratory health of the exposed versus controls was reported as excellent (54.5% vs 73.4%), good (27.3% vs 23.3%) and average (18.2% vs 3.3%) respectively. The exposed group on contrary to control one has decreased mean values for FEV1 (3.12 vs 3.50), FVC (4.12 vs 4.43), FEV1/ FVC % (79.60 vs 80.79) and PEF (414.77 vs 523.16). The present study reveals that exposed workers are at increased risk of developing respiratory symptoms and decreased pulmonary functions as compared to unexposed. Such exposure research studies are instrumental in health status evaluation of workers. However, this area has been neglected by the researchers in Saudi Arabia. It is, thus, strongly recommended to carry out prospective studies to substantiate the study results including large sample size, background pollutants concentrations and biological monitoring. Control strategies should be adopted to reduce the vapor concentration in the ambient air, protect and promote respiratory health of workers.