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To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice. Cross-sectional surveys. Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study. All HCWs performing direct patient care in the study ICUs were eligible to participate. Surveys were performed first during the BUGG intervention study period (July-September 2012) with universal gowning/gloving and again after BUGG study conclusion (October-December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift. A total of 348 HCWs participated (21-92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2-0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2). Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear.   To determine the effect of men's lacrosse equipment on chest compression and ventilation quality on patient simulators.   Cross-sectional study.   Controlled laboratory.   Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years).   In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators.   Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions.   Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions ( P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume ( P = .002, effect size = 0.598) across all equipment conditions.   For a men's lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.

Introduction Following a chemical, biological, radiation and nuclear (CBRN) incident, prompt establishment of an advanced airway is required for patients with respiratory failure within the warm zone, while wearing personal protective equipment (PPE). Previous studies reported that intubation attempts were prolonged, and incidence of esophageal intubation was increased with conventional Macintosh laryngoscope (McL), while wearing CBRN-PPE. Pentax-AWS (AWS), a recently introduced portable video laryngoscope, was compared with the McL to test its utility for tracheal intubation while wearing CBRN-PPE. Methods 31 participants performed unsuited and suited intubations on an advanced life support simulator. The sequence of intubating devices and PPE wearing were randomised. Time to complete tracheal intubation (primary end point), time to see the vocal cords, overall success rate, percentage of glottic opening, dental compression and ease of intubation were measured. Results Suited intubations required significantly longer time to complete intubation than unsuited intubations, in both McL and AWS (22.2 vs 26.4 s, 14.2 vs 18.2 s, respectively). However, suited AWS intubations required shorter time to complete tracheal intubation than unsuited McL intubations (18.2 vs 22.2 s). In secondary outcomes, moreover, suited intubations using the AWS compared favourably with unsuited intubations using the McL. Conclusions Although the CBRN-PPE adversely affected time required to complete tracheal intubation with the AWS, suited intubations using the AWS were even superior to unsuited intubations using the McL. The AWS should be a promising device to perform tracheal intubation while wearing the CBRN-PPE.

Load carriage increases physiological strain, reduces work capacity and elevates the risk of work-related injury. In this project, the separate and combined physiological consequences of wearing the personal protective equipment used by firefighters were evaluated. The overall impact upon performance was first measured in 20 subjects during a maximal, job-related obstacle course trial and an incremental treadmill test to exhaustion (with and without protective equipment). The fractional contributions of the thermal protective clothing, helmet, breathing apparatus and boots were then separately determined during steady-state walking (4.8 km h −1 , 0% gradient) and bench stepping (20 cm at 40 steps min −1 ). The protective equipment reduced exercise tolerance by 56% on a treadmill, with the ambulatory oxygen consumption reserve (peak minus steady-state walking) being 31% lower. For the obstacle course, performance declined by 27%. Under steady-state conditions, the footwear exerted the greatest relative metabolic impact during walking and bench stepping, being 8.7 and 6.4 times greater per unit mass than the breathing apparatus. Indeed, the relative influence of the clothing on oxygen cost was at least three times that of the breathing apparatus. Therefore, the most efficient way to reduce the physiological burden of firefighters’ protective equipment, and thereby increase safety, would be to reduce the mass of the boots and thermal protective clothing.

Hypothermia caused by cold water immersion is one of the main causes of death in marine accidents. Immersion suit is a kind of protective clothing when implementing flying tasks over the sea in cold seasons, with the main function to slow down the loss of human heat in water and prolong the survival time. In this study, the thermal properties and wearing types of immersion suit and underwear were analyzed. The subjects with internal- and external-wear immersion suit exposed to the experimental environments for 2 h in five working conditions. The core temperature, weighted average skin temperature, and average body temperature were measured and calculated. Both internal- and external-wear immersion suits could fulfil the cold protection requirements under the experimental conditions. The results of clothing parameter tests and physiological experiments both exhibit that the external-wear immersion suit has better thermal insulation effect. And the tolerance time in low-temperature water was predicted, which is crucial for effective and efficient rescue during shipwreck in adverse thermal scenarios. In future research, a comprehensive evaluation and analysis of the thermal insulation performance of immersion suit could be completed in combination with the water ingress of the clothing, the subjects’ thermal comfort, and flexibility of the clothing.

Background In medical settings, lead aprons provide protection from ionising radiation but also result in physical strain that may lead to musculoskeletal complaints (MSCs). These complaints may have an impact on the wearer’s professional or private life. Therefore, we aimed to assess the 12-month prevalence of MSCs among physicians with different exposure times to lead aprons, and to determine the proportion of MSC-related restrictions in work or leisure time. In addition, we investigated potential confounding factors associated with MSC-related restrictions. Methods The study population consisted of physicians working full- or part-time. The data were collected between December 2023 and February 2024 using the German version of the Nordic Musculoskeletal Questionnaire. The prevalence of MSCs and MSC-related restrictions was recorded in four body regions: neck and cervical spine, thoracic spine, lumbar spine and lower back, as well as the shoulder joints and upper arms. We conducted a multivariate logistic regression (odds ratio; 95% confidence interval) to identify potential occupational and personal confounding factors. Results A total of 461 questionnaires were evaluated. Eighty-seven per cent of participants reported regularly wearing a lead apron for at least one year as part of their work. The prevalence of MSCs varied depending on the body region, ranging from 50 to 82%. Between 21% and 44% of the respondents reported MSC-related restrictions at work or in their leisure time. A significant correlation was identified between awkward postures and MSC-related restrictions in all body regions. Lead apron exposure (more than 20 years) increased the likelihood of experiencing MSC-related restrictions in the shoulder joints and upper arms (OR = 2.3; 95% CI = 1.036–4.943). Performing more than 100 procedures per year increased the likelihood of experiencing MSC-related restrictions in the thoracic spine (OR = 1.6; 95% CI = 1.005–2.670). Conclusions This study revealed that MSCs are prevalent among this study population, particularly those affecting the lumbar and cervical spine. Awkward postures at work had a significant impact on MSC-related restrictions in all body regions, whereas wearing a lead apron over several years resulted primarily in MSC-related restrictions affecting the shoulder joints/upper arms. Additional analyses are needed to identify activities that cause physical strain, and determine appropriate, targeted preventive measures.

Submariners of disabled submarines are subject to drastic weather changes as they are awaiting rescue on the sea surface. Hyperthermia and hypothermia are just two of the adverse conditions that they can experience. The purpose of this study was to investigate the effectiveness of two models of submarine escape and the protective capabilities of immersion suits from environmental changes. A randomized study involving 24 male subjects was conducted to compare the thermal capabilities of the full- versus half-configuration suit in a climate-controlled chamber. The full-configuration suits tested for a higher mean maximal core temperature (37.76 degrees C / 99.97 degrees F) than the mean maximal core temperature of the half-suits (37.52 degrees C / 99.54 degrees F). The full suits also tested for a higher mean minimal core temperature (36.13 degrees C / 97.03 degrees F) than the mean minimal core temperature (35.95 degrees C / 96.71 degrees F) of the half-suits. Results showed that the full-suit configuration did not induce clinically significant high levels of heat stress as compared to the half-suits, but instead provided better thermal protection against hypothermia than the half-suits.

OBJECTIVE:To determine the effects of wrist cooling on recovery from exercise-induced heat stress (EIHS) from wearing firefighting personal protective equipment (PPE) and self-contained breathing apparatus. METHODS:Using a single-blind, counterbalanced, crossover-design, in 11 healthy men, we measured heart rate (HR), HR variability (HRV), core temperature (TCore), thermal strain (TS), and fatigue at rest, during 30-minute of exercise in PPE+SCBA, and during recovery while wearing a wrist cooling band (control[off] vs cool[on]). RESULTS:No differences were observed between trials at baseline or during exercise, in HR, TCore, TS, or fatigue. Time to 50% and recovery were not different between trials. Upon recovery, TCore was lower, while HR, fatigue, HRV, and TS were relatively indifferent with cooling. CONCLUSION:Wrist cooling after EIHS only modestly enhanced recovery, questioning its implementation during on-scene rehabilitation of firefighters.

We determined the efficacy of the use of permethrin-impregnated uniforms for prevention of malaria and leishmaniasis in a double-blind, randomized study of Colombian soldiers on patrol. In the study of malaria, soldiers were issued impregnated uniforms (i.e., a shirt, an undershirt, pants, socks, and a hat) or uniforms washed in water; the soldiers wore the uniforms day and night for a mean of 4.2 weeks and were observed for an additional 4 weeks. Three (3%) of 86 soldiers wearing impregnated uniforms contracted malaria, whereas 12 (14%) of 86 soldiers wearing control uniforms contracted malaria (P = .015). In the study of leishmaniasis (soldiers were in the area of endemicity for 6.6 weeks and were observed for 12 weeks thereafter), 4 (3%) of 143 soldiers wearing impregnated uniforms and 18 (12%) of 143 soldiers wearing control uniforms acquired disease (P = .002). In the leishmaniasis study, and presumably in the malaria study, breakthrough infections in the treated group were primarily due to bites in unclothed regions of the body (face and hands). Permethrin-treated uniforms were virtually nontoxic (there were only two cases of mild skin irritation among 229 subjects), and impregnation is quick and inexpensive. Impregnation of clothing with permethrin is suggested for nonimmune populations who are likely to be exposed to malaria or leishmaniasis over a period of 1–2 months.

Military personnel are often required to wear ballistic protection in order to defend against enemies. However, this added protection increases mass carried and imposes additional thermal burden on the individual. Body armor (BA) is known to reduce combat casualties, but the effects of BA mass and insulation on the physical performance of soldiers are less well documented. Until recently, the emphasis has been increasing personal protection, with little consideration of the adverse impacts on human performance. The purpose of this work was to use sweating thermal manikin and mathematical modeling techniques to quantify the tradeoff between increased BA protection, the accompanying mass, and thermal effects on human performance. Using a sweating thermal manikin, total insulation (IT, clo) and vapor permeability indexes (im) were measured for a baseline clothing ensemble with and without one of seven increasingly protective U.S. Army BA configurations. Using mathematical modeling, predictions were made of thermal impact on humans wearing each configuration while working in hot/dry (desert), hot/humid (jungle), and temperate environmental conditions. In nearly still air (0.4 m/s), IT ranged from 1.57 to 1.63 clo and im from 0.35 to 0.42 for the seven BA conditions, compared to IT and im values of 1.37 clo and 0.45 respectively, for the baseline condition (no BA). Biophysical assessments and predictive modeling show a quantifiable relationship exists among increased protection and increased thermal burden and decreased work capacity. This approach enables quantitative analysis of the tradeoffs between ballistic protection, thermal-work strain, and physical work performance.