Here, we propose using drones to deliver PPEs to the most vulnerable (hospitals, long-term care center), thereby reducing human-human contact which would help to alleviate cluster infections. In high concentrations, ozone can be quite hazardous, but when used in a controlled manner at moderate concentrations, it might prove to be very effective at sterilizing PPE. Home made masks simulating N 95 respirators, Home-made masks simulating N95 masks with four layers- two outer layers of polypropylene, middle layer of polyester and inner layer of polypropylene may prove to be very useful. One mask/sterilizer combo could replace hundreds of N 95 masks. The UVGI method and application to N95 masks specifically were studied after the SARS, MERS and Ebola outbreaks of 2000’s - wherein a shortage of N95 masks in each emergency reduced the effectiveness of frontline healthcare providers or. By slowing the spread of the virus, we increase the chance that everyone who needs care can get the care they need, and fewer people might end up becoming really sick or dying. Social distancing (also known as “physical distancing”) means deliberately (carefully) increasing the physical space between people to avoid spreading illness. COVID-19 is 1 micron. Reuse of Masks and PPE by disinfection with Large Scale Ozone, Use of Phase Change Material under PPE during warm season. We have developed a face mask map in Taiwan. can be set up in acute care wards, post-acute facilities, temporary pop up hospitals or even sequestered hotel type structures. Cu2+ ions have been shown to increase degradation of lipid membrane-coated viruses. The headpiece itself may or may not be in short supply, though that is able to be custom-made or production can be ramped up easily. The collaboration and ties between the two countries run deeper, especially in trying times like this. Many nonstandard N95 alternatives have been suggested. Have Effective and Established Bidirectional Communication Channels with Frontline Staff. The lowest achievable average temperature in many residential convection ovens is 77-100°C, and this offers an immediate means of virus inactivation. It’s a fundamental part of our training. Take care of your body. CDC estimates that 35% of coronavirus patients don't have symptoms. Related to COVID-19’s mortality rate, is the number of patients who need to be admitted to hospitals and need ventilation to help support their breathing.The CDC’s best estimate is that 3.4% of people with Covid-19 symptoms will require hospitalization, rising to 7.4% for people 65 and older.6. No one in the home should share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with the care recipient. They also do not use disposable coveralls; these too are washed for reuse. is also used for medical, food, and workplace disinfection, including hand washing or surgery, and even as a  mouthwash (2, 3). Not a huge savings, but an easy step to take. Discard gloves after each cleaning. Here's an example of an ozone generator being used in a medical research lab environment. According to a 2000 article (1), taping a classic surgical mask to create a seal improves its protective factor by nearly double for each of five volunteers evaluated. I have been a nurse since 1997. Hospitals can also commandeer many toy and water UV-C disinfection units for smaller items. We have all been trained to put hands on all patients. If I were a doctor, I would "cook" all my stuff over night. dozens of people in a waiting room. The CDC maintains a list of general travel recommendations and international travel restrictions to help reduce the spread of COVID-19. (2020, March 10). Make sure that shared spaces in the home have good airflow, such as by an air conditioner or an opened window, weather permitting. By connecting to 10-15 liters per minute of oxygen, we are able to maintain a breathable environment within the bag with measured CO2 remaining at a stable 10-15 mmHg. and wear gloves from patient to patient. I’m using my CPAP ResMed AirFit F20 half-face masks with cotton Tshirt or paper towel filters placed between the plastic layers as COVID-19 masks. There are several factories in other countries (including China) that have PPE supplies, and these suppliers are ready to provide the PPE at minimal cost. Here are some steps you can take help cope with stress and support yourself mentally and physically: Practice social distancing and good hygiene to protect your loved ones. However, the guidelines for the methods were greatly unclear and the thought of “reuse” was objected by some of international health authorities. It is a waste of time, energy and resources. collecting samples, proning patients, or inserting lines); Chest radiography is widely used for the screening and diagnosis of COVID-19. Another published discussion on the disinfection of medical masks suggested that home-based baking (i.e., dry heat) medical masks at 70℃ for 30 mins (preheat the oven before use) (2). An immediate solution would be for those cities' mass transit to call for a mandatory donation of a portion of those masks to hospitals in their municipality reporting the greatest shortages. The filter disks can be re-used for up to six months, and sterilized in UV. Many of the proposed alternatives to respirator-grade filtration use non-disposable hardware which can then be sterilized, such as scuba masks and anesthesia facemasks. (2020, March 6). COVID-19 needs a host to survive--it can survive on a metal surface for up to 48 hours, on plastic for 72 hours, and on cardboard for 24 hours. Increasing PPE supply and their Protection: Use Food Prep, Welding, Construction Faceshields. If the filter is removed from its carboard frame you can form a pocket around the top snorkel which has no appreciable resistance to breathing if appropriately sized. If one person has the flu, they are likely to pass it on to at least one other person. These groups are also most likely to get more sick more quickly. Retrieved March 19, 2020, from https://www.hhs.gov/answers/public-health-and-safety/what-is-the-difference-between-isolation-and-quarantine/index.html, 13Interim Guidance: Home Care for 2019-nCoV. Some bedbug sheets have 1 micron porosity (WAY better than most fabrics and such) and is breathable - and can be laundered - and one sheet could make over 200 masks. Many (most?) We also have data to show this would be effective for SARS and MERS. It has not previously been seen in humans. We are starting to run out of PPE. (n.d.). Dr. Wexler's comment recommending staffing COVID wards with naturally immune staff to obviate the need for PPE is an excellent expansion of Dr. Weddington's COVID-only ward comment. In line with ADA guidance, he has closed his practice for all but significant dental emergencies. that uses a gown, a cap, protective glasses, gloves, a facemask, and shoe-cover. Many occupations use hard full face shields, which could be repurposed for medical use. helmet in Utraviolet light, change into new scrubs and glove again for the next shift. Omnipresent electronic multicookers like the Instant Pot are designed for unattended use by laypersons. On online video demonstrates how to create an N95/100-like respirator from CPAP equipment (1). be warned to donate the supplies or sell at pre-COVID prices till 'x' date to medical centers, after which they would be prosecuted, and any supplies confiscated. observation of nursing staff. Extended Dwell IV catheters are a particularly durable version of peripheral IV that has a dwell time of ~29 days and has the added benefit that one can draw blood from them. Intubation boxes have been proposed. Retrieved March 18, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html, 11Coronavirus, Social Distancing and Self Quarantine. Do not reuse them. Heating a bathroom or closet may require cords connected to just two circuits. Colleges and universities also have cleaning supplies that could be donated. I looked but did not find any heat-sensitivity study for COVID-19 virus, but the SARS-coronavirus can be effectively eliminated at 56-65 deg C for 30-90 minutes (1). Comment form Danielle Jackson, MD MPh to ask for transit agencies to donate a portion of any of their stockpile inspired a potentially useful idea -- have a distributed donation drive where the transit system can potentially be used as mobile collection centers. Authoritative input on this would be welcome. I am now based in Los Angeles but the rest of my team are China and HK. Our facilities guys retrofitted it for negative pressure. Even before the COVID-19 pandemic, as a pediatric hospitalist I have witnessed many patients being kept in isolation precautions for days, if not their entire hospitalization, despite some disease-specific guidelines at my institution recommending PPE only until appropriate therapy has been administered for 24 hours. I suspect that EtO would work well and probably even a chlorine bleach vapors. Regarding re-use, some kind of sterilization is probably necessary. Conserving Supply of Personal Protective Equipment—A Call for Ideas. it is effective and allows reuse of masks. However, taking a hair dryer for 30mins for inactivation of virus only for one medical mask might be very inefficient. This decision should be made by their health care provider, possibly in consultation with state and local health departments. care for more patients during this surge as eConsults usually require less time than an in-person consult. Originally our whole body narrow-band UV-B phototherapy lights were primarily used for treatment of my vitiligo and psoriasis patients, and when SARS-CoV-2 first emerged on Guam, I applied the proven science of UV radiation in the safe application to conserve our PPE for reuse provided that the protective gear had no contaminated. An individual could be issued 4 masks and 4 storage boxes (or hooks on a wall if space allows). An easy solution: buy a motorcycle helmet with shield, wear a N95 mask beneath. Relevant regulatory agencies could issue emergency blanket waivers to permit expedited PPE importation from overseas. energy as delivered by microwave ovens has also been shown to have some efficacy in deactivating viruses (1). It remains preferential to both extend use and reuse sterilized PPE, such as N95 masks designed for COVID19 viral protection, even if degraded, over accepting any amount of new inferior filtration masks never designed to protect against the exceptional viral load shedding observed in this disease. While supply is managed by hospital administration, the use of PPE by healthcare workers can be optimized by bedside personnel. Isolation and treatment centers need to be staffed to the maximum extent possible by people with natural immunity after recovery from COVID-19 who can work without PPE. Our technology is now accomplishing two different tasks: sterilizing infectious waste and re-processing disposable PPE. These are small and portable devices currently used in many private and some governmental centers around the world for several clinical conditions. Search Construction Equipment by Manufacturer, Model, Category and more at MachineryTrader.com. Read and follow directions on labels of laundry or clothing items and detergent. Julie Davis RN CSN, Registered Nurse BSN CSN, I have been doing live video RN consulting in my school district for at least 2 years. I posted photos and details of a DIY ozone sterilizer suitable for N95 masks at xyztek.com. Many other industries use PPE for very elective things. The Johns Hopkins website tracks cases daily. As such, they are particularly susceptible to severe complications and mortality from COVID-19. I did a bit of research yesterday hoping to find an easy way to do mass sterilization of used masks. Maria de Lurdes Enes Dapkevicius, A. The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities (Rutala et al. I recommend short wavelength UV sterilization of PPEs in a moist environment. I have read ideas here about using an ozone compressor, but could not find ideas of how to sterilize large quantities of PPE simultaneously. can be encouraged at a state-by-state or national level. We need more time for our system to complete research and development for evidenced-based prevention and treatment. Here in Washington State there is the Hanford Site that was used to make nuclear weapons and whose mission mow is containment of waste generated over the last 60 years. waste is controlled. SonoviaTech.com in Israel is manufacturing zinc-oxide (ZnO)- impregnated textiles that in vitro and in clinical trials are shown to kill all bacteria, even MRSA, and materially decrease nosocomial (hospital associated) infections. Many uncertified products are not effective (1). This platform should display the requirement(s) in addition to the availability of PPEs for the at-risk groups. and there may be one in your community. Take A Sneak Peak At The Movies Coming Out This Week (8/12) Jamie Lee Curtis offers support on 22nd sober anniversary; Oprah Winfrey welcoming Ciara and Jennifer Garner to WW event I don't understand why hospitals haven't jumped on this. We propose decontamination of PPE using UV germicidal irradiation (UVGI) exposure so masks can be safely reused. There are some studies, as already pointed out by other commenters, that demonstrate reusable elastomeric respirators that can be effectively disinfected and reused, especially if done in a systematized way. As a part our state’s (California) Pandemic Preparedness Program in 2006, we realized the supply chain would be compromised during a true pandemic. or a senior healthcare provider). the respirator in the kitchen oven to do the sterilization. For tutoring please call 856.777.0840 I am a recently retired registered nurse who helps nursing students pass their NCLEX. The sophisticated facial masks that we see on the media are out of the realm of possibility for most small clinics in my country. A principle I have seen to great effect from my service days. Please remember to contact your state government. When sampling, it can cover the patient's mouth and nose. Alternative Personal Particulate Filtration During N95 shortage. Travel increases the chance of getting and spreading COVID-19. These unusual times call for innovative, thoughtful, and expedited actions. (2020, March 7). I bought one on Amazon for $26, and I’m awaiting its arrival in 5 days. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. (n.d.). So we are looking for ways to sterilize and reuse N95 masks and Tyvek coveralls and hoods. We found 3 common reasons patients were in unnecessary isolation: be isolated or not, so full isolation was ordered as a protective measure. Dry hands and sore, cracked cuticles result when the skin loses moisture, often caused by exposure to wind, cold … Retrieved March 25, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html, 20Preventing 2019-nCoV from Spreading to Others. to relevant articles below). Express yourself. reveals that exposure to shorter wavelengths (far-UVC ~220nm) maintains the germicidal efficiency of UVC while offering mammalian skin protection [2,3]. UNK the , . Not all submitted comments are published. led all to presume that asymptomatic spread is likely a common mode of transmission. concentrating PPE from other non-hospital locations, creating respirators and surgical masks from non-traditional supplies, getting industries to start manufacturing PPE) or decreasing demands. To prevent the virus from spreading, many countries have implemented restrictions on travel. The current but preliminary evidence rejected the use of ultraviolet radiation (UVC) and sunshine exposure (UVA and UVB) because of doubtful of weak penetration power of UVC and poor disinfection power of UVA and UVB. Reusable gowns for patients in contact isolation have already been deployed at large medical centers (1), with the primary motivation being an overall reduction in waste and greenhouse gas emissions associated with the manufacture, transportation, and disposal of one time use gowns. These treated masks can be worn by the same user again. The device is protected by China's national utility model patent, and an application for an invention patent, The long term PPE solution will need to be something reusable. Vendors such as Steris (2) or similar, there are other vendors in this market, can sterilize collected masks and a dedicated repossessing vendor like Midwestern Reprocessing Center (1), or similar (3) would be able to sort, mark, and package the decontaminated masks. of the two viruses is sufficiently similar to warrant rapid research of this option (3). Our website uses cookies to enhance your experience. Theodore Murphy, MB BCh BAO NUI MRCPI MSc. In this period of clear national need, waivers could help open the door for immediate needs and restocking. (2020, March 4). With the closure of schools nationwide, there may be a significant number of PPE sitting in Health Service Offices for K-12 schools including the Private school and Charter School systems along with Universities On-Campus Clinics. My institution’s infection control department has now implemented only standard precautions for patients with colonized MRSA and VRE (ESBL not included). Perhaps food shortages represent the best analogue to the current shortage of Personal Protective Equipment (PPE), in the context of the COVID-19 pandemic. The Biomedical Engineering and Radiation Oncology Departments at GWUH have been collaborating to come up with a series of policies to conserve and extend PPE and procedures to create new resources. By comparison, if one person has measles (a highly contagious disease), they are likely to pass it on to at least 18 others. Why are Ambulatory Surgical Centers Still Doing Elective Surgeries? Retrieved March 18, 2020, from https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html, 19Strategies for Optimizing the Supply of Facemasks: COVID-19. The temperature and exposure time to get desired efficacy needs to be determined (I bet some data has already been published somewhere). Someone with a sewing machine could make 30 masks a day, so 500 community volunteers could produce 60,000 in 4 days. Constructing PPE with Materials More Likely to Be Well Supplied. CuSO4 that ends up being inhaled is safe. Ellard Hunting, PhD - (Microbial ecology), Focus Healthcare Products UV (UltraViolet) Box was designed for hospitals by nurses to kill 99.9% of pathogens that reside on a cell phone or tablet in 55 seconds. 10 minutes processing time will kill all pathogens. The EarlySense system is being used in Israel at Sheba Medical Center to help protect staff and minimize contact with patients (1). They are made by various manufacturers and come in different sizes. 2013;55(12):1484-1488. Adults are at increased risk of severe illness or death if they are severely obese (body mass index [BMI] of 40 or higher), or have a chronic comorbid (existing and unrelated) illness such as heart disease or diabetes.5. the physical integrity of the mask. I did the research on the filter material and vacuum cleaner bags or HVAC filters would probably work better. Retrieved April 28, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html, 6Azad, A. Visit the CDC’s website for up-to-date information. There are so many outstanding ideas here. Shorten Procurement Through Transparency with Suppliers for Just-In-Time procurement. I own a hockey equipment cleaning business in Michigan, and my brother told me about this article / said that people were asking about practical ozone applications. Boursorama … First are community volunteers who have recovered from infection. Repeatedly, we have heard this pandemic likened to times of war. Worth repeating is that PPE is considered the least effective and last resort in the management of worker health. Decontaminated devices are then washed to restore them to the look and feel of a new product. (2) This. of international students at major US academic institutions. Chief Scientific Officer and Shareholder of HepC, Inc. A nurse conducted daily review to identify patients eligible for transmission-based precaution (TBP) discontinuation so as to conserve PPE. There's old data indicating that the material used in masks matters less than the fit (1). Adoption of the procedure is at the practitioners own risk. Building on the March 21 Cpap Full-face masks "bush" approach and Mar 23 Cpap full-face mask modification for replacing hose with a filter we should extend this to partial-face masks with some additions as well. It is the goal of this submission to briefly summarize the effectiveness of such an option for the medical, and political decision makers who are driving the outcomes of this disaster, and to positively influence their decisions, without the requirement for reading the extensive technical research in the area. We look forward to the supply of PPE expanding, but in the meantime we are grateful to our community volunteers who have allowed us to serve patients in the assisted living facilities and suspect other communities can muster this volunteer resource to assist. Susanne Manthey, Architect, Berlin Germany, Fundraising campaign for protective equipment for use in the medical field and by the emergency services, of Statutory Health Insurance Physicians) of the federal states, Richard Collins, MD, Boarded in Cardiology, The best method is to protect the head, respiratory system, eyes, nose and oral airway. Identify all potential conflicts of interest that might be relevant to your comment. (2020, March 14). How can those outside of medicine share our expertise and fabrication skills? There are numerous benefits including the early detection of deterioration and the reduction of exposure of healthcare workers. The idea behind this step is one, to prevent unnecessary infectious exposure to students, and, second, to prevent more than 1 PPE being utilized per patient encounter (as every case seen by a student, also needs to be supervised by an attending physician. Ultraviolet germicidal irradiation (UVGI), particularly UV-C, has been shown to irradiate viruses. All health care professionals, including direct care workers, are at a higher risk of getting COVID-19 because of the older and sicker population you care for. The amount of available PPE depends not only on supply, but also on careful minimized use. For example, some have advocated for 3D printing masks or ordering mylar and elastic to construct facemasks. Tenemos algunas fotos, ebavisen ikya asr llama a las acciones de las niñas por una cierta historia islámica, salimos de una categoría con nombre, tenemos algunas fotos, eile lover ama a los jóvenes … It would be quick & cheap to test if N95 masks sprayed on the outside with CuSO4 solution and allowed to dry inactivated the virus much faster; if so, then we just need to figure out how low a concentration still works and make sure that the amount of. I imagine this is true for thousands of high schools across the country. This is a perfect easy system for which the infrastructure already exists. This means avoiding places where people meet or gather; avoiding local public transportation (such as buses, the subway, taxis, and rideshares), if possible; and maintaining distance (approximately 6 feet or 2 meters) from others.9, Since COVID-19 may be caught from people who have no symptoms, social distancing is especially important for reducing the spread of COVID-19.10. There should be no cosmetic surgeries, no cataract extractions, no joint replacements, and no screening colonoscopies. thin enough to give good overall heat transfer coefficient. I am strategically helping SonoviaTech.com. The situation then mirror what happens now in Italy and Spain. Ozone has been used successfully for sterilization in medical research. A cough releases up to 3,000 droplets, which is equivalent to an amount released by normal talking for 5 minutes. of healthy adults under 30 will recover quickly and mortality was 0% in this group in Korea. As the nostrils and mouth are the most likely point of contact and the closest portal of entry for the virus, I am recommending that washing one's face is as important as one's hands when coming in contact with possible sources of contamination. assembly, the respirator was donned by a test subject and a quantitative fit testing was performed. The results have been very successful. Retrieved March 18, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/prepare/animals.html, 36COVID19 - Caring for someone at home. Unit directors or nursing managers should be able to carry it in the,. Lowe 's team validate that lipid membrane-coated viruses in homemade masks to Donate to local hospitals hopefully any.: immediately clean your hands African regions, academics and researchers are also most likely cause! Uses a gown, a cap, protective face shield or goggles for more patients during this surge econsults... 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