Personal protective equipment and risk for avian influenza (H7N3).
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ABSTRACT:
SUBMITTER: Morgan O
PROVIDER: S-EPMC2662632 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We analyzed the effectiveness of personal protective equipment and oseltamivir use during the 2003 avian influenza A (H7N7) epidemic in the Netherlands by linking databases containing information about farm visits, human infections, and use of oseltamivir and personal protective equipment. Using a stringent case definition, based on self-reported conjunctivitis combined with a positive hemagglutination-inhibition assay, we found that prophylactic treatment with oseltamivir significantly reduced the risk for infection per farm visit from 0.145 (95% confidence interval [CI] 0.078-0.233) to 0.031 (95% CI 0.008-0.073). The protective effect was ≈79% (95% CI 40%-97%). These results are comparable with the reported effect of prophylactic treatment with oseltamivir on human seasonal influenza. No significant protective effect was found for use of respirators or safety glasses, possibly because of limitations of the data.
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Project description:The COVID-19 outbreak put healthcare systems across the globe under immense pressure to meet the unprecedented demand for critical supplies and personal protective equipment (PPE). The traditional cost-effective supply chain paradigm failed to respond to the increased demand, putting healthcare workers (HCW) at a much higher infection risk relative to the general population. Recognizing PPE shortages and high infection risk for HCWs, the World Health Organization (WHO) recommends allocations based on ethical principles. In this paper, we model the infection risk for HCWs as a function of usage and use it as the basis for distribution planning that balances government procurement decisions, hospitals' PPE usage policies, and WHO ethical allocation guidelines. We propose an infection risk model that integrates PPE allocation decisions with disease progression estimates to quantify infection risk among HCWs. The proposed risk function is used to derive closed-form allocation decisions under WHO ethical guidelines in both deterministic and stochastic settings. The modelling is then extended to dynamic distribution planning. Although nonlinear, we reformulate the resulting model to make it solvable using off-the-shelf software. The risk function successfully accounts for virus prevalence in space and in time and leads to allocations that are sensitive to the differences between regions. Comparative analysis shows that the allocation policies lead to significantly different levels of infection risk, especially under high virus prevalence. The best-outcome allocation policy that aims to minimize the total infected cases outperforms other policies under this objective and that of minimizing the maximum number of infections per period.
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Project description:Confronted with an emerging infectious disease at the beginning of the COVID-19 pandemic, the medical community faced concerns regarding the safety of autopsies on those who died of the disease. This attitude has changed, and autopsies are now recognized as indispensable tools for understanding COVID-19, but the true risk of infection to autopsy staff is nevertheless still debated. To clarify the rate of SARS-CoV-2 contamination in personal protective equipment (PPE), swabs were taken at nine points in the PPE of one physician and one assistant after each of 11 full autopsies performed at four centers. Swabs were also obtained from three minimally invasive autopsies (MIAs) conducted at a fifth center. Lung/bronchus swabs of the deceased served as positive controls, and SARS-CoV-2 RNA was detected by real-time RT-PCR. In 9 of 11 full autopsies, PPE samples tested RNA positive through PCR, accounting for 41 of the 198 PPE samples taken (21%). The main contaminated items of the PPE were gloves (64% positive), aprons (50% positive), and the tops of shoes (36% positive) while the fronts of safety goggles, for example, were positive in only 4.5% of the samples, and all the face masks were negative. In MIAs, viral RNA was observed in one sample from a glove but not in other swabs. Infectious virus isolation in cell culture was performed on RNA-positive swabs from the full autopsies. Of all the RNA-positive PPE samples, 21% of the glove samples, taken in 3 of 11 full autopsies, tested positive for infectious virus. In conclusion, PPE was contaminated with viral RNA in 82% of autopsies. In 27% of autopsies, PPE was found to be contaminated even with infectious virus, representing a potential risk of infection to autopsy staff. Adequate PPE and hygiene measures, including appropriate waste deposition, are therefore essential to ensure a safe work environment.
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