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Diagnosis of Active Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
There are a number of operational limitations of sputum collection for TB diagnosis. Most important are infection control concerns, as expectorating sputum produces cough aerosols which may lead to nosocomial spread of TB. Thus, health workers should wear personal protective equipment such as N95 particulate respirators, and, where resources allow, sputum and respiratory samples should be collected in rooms equipped with negative-pressure ventilation and high-efficiency particulate exhaust systems; sterilization of the air with ultraviolet germicidal irradiation (UVGI) following the procedure adds an additional measure of protection.50 If such facilities are not available, specimens should be collected away from other patients where there is adequate natural ventilation and plenty of sunlight. Second, not all patients are able to expectorate sputum, especially young children. At least 1–5 mL of good quality, non-salivary sputum, should be collected, but the best available specimen should be analyzed.38 In individuals who cannot expectorate on an initial request and with coaching, it is worth making a second request for sputum at a later time, before moving on to sputum induction or bronchoscopy.
Multidrug-Resistant Tuberculosis (MDR-TB)
Published in Meera Chand, John Holton, Case Studies in Infection Control, 2018
Helen McAuslane, Dominik Zenner
Specific technological measures, which can help to reduce or eliminate infectious aerosols from the ambient air, are high-efficiency particulate air (HEPA) filters and ultraviolet germicidal irradiation (UVGI). The latter works through UV light sterilization of airborne droplet nuclei, but its use is limited by cost and health and safety considerations around the use of UV light.
Extended Use and Disinfection of N95 Respirators and Exam Gloves During a Pandemic *
Published in Robert N. Phalen, Howard I. Maibach, Protective Gloves for Occupational Use, 2023
R.N. Phalen, J-M. Lachapelle, Y.K. Hamidi
The CDC has continued to update its “Strategies for Optimizing the Supply of N95 Respirators,” which specifies guidelines on the limited reuse of N95 respirators during known shortages.2 It includes the following recommendations for users:Consult with the manufacturer regarding the maximum number of reuse and donning activities that can be performed with its N95 respirator. Redonning an N95 respirator could reduce its fit and effectiveness.As a default, the CDC recommends that N95 respirators not be reused or redonned more than five times. A proper pre-use inspection and user seal check should occur prior to each reuse.Protect against contamination by wearing a face shield or face mask over the N95 respirator.As a limited reuse strategy, rotate products to reduce the risk of self-contamination between uses. The CDC recommends rotating N95 respirators with at least 72 hours of storage in a breathable paper bag before reuse. This recommendation is based on evidence that the SARS-CoV-2 virus would no longer be viable after this time has elapsed. However, as the CDC acknowledges, evidence in the peer-reviewed literature suggests a storage time of seven days may be more appropriate.4When a shortage exists and rotation is not feasible, seek proper decontamination methods. The CDC first recommends consulting the manufacturer or third-party expert organizations or laboratories for information on how to decontaminate the specific N95 respirator without affecting its performance. In the absence of these guidelines, the decontamination strategies recommended by the National Institute for Occupational Safety and Health (NIOSH) include ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat. This chapter provides additional details on the decontamination of N95 respirators.
Personal protective equipment during COVID-19 pandemic: a narrative review on technical aspects
Published in Expert Review of Medical Devices, 2020
Sai Saran, Mohan Gurjar, Arvind Kumar Baronia, Ayush Lohiya, Afzal Azim, Banani Poddar, Namrata S. Rao
Shortage of high-quality PPE is a worldwide problem during pandemics, and this can be mitigated by ramping up of local production units, and by avoiding overuse of PPEs by interventions such as reuse with sterilization and use of smart technology to minimize numbers of on-floor health-care workers [12]. Few guidelines, although balancing the risk of infection follow the extended use and reuse of N95 respirators as the last resort[64]. These suggest that the RPDs (FFP 2,3/N 95) can be reused if they are neither damaged nor soiled and if they are folded such that the outer surface is held inward and against itself and stored in a sealable bag[65]. The scarcity of respirators created re-use with various techniques of disinfection like ultraviolet germicidal irradiation (UVGI), hydrogen peroxide vapor, ethanol, etc., with other less effective disinfection methods like microwave, steam, bleach are also being used reflecting the scarcity [66].
Chapter 14: Prevention and control of tuberculosis transmission in healthcare settings
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
B. Lynn Johnston, Toju Ogunremi, Katherine Defalco, Noémie Savard, Stephanie W. Smith
Ultraviolet germicidal irradiation (UVGI) is effective at inactivating airborne bacteria and in reducing the risk of M. tuberculosis transmission.55–57 Upper-room UVGI directs UV-C energy to the upper portions of a room to create a disinfection zone so that pathogens in the air that pass through this disinfection zone are inactivated.58 The effectiveness of upper-room UVGI depends on multiple factors, including UVGI dose, air circulation, ventilation, temperature, humidity, room configuration and proper UVGI system installation and maintenance.
Masks in COVID-19: let’s unmask the evidence
Published in Expert Review of Respiratory Medicine, 2021
Arjuna P. De Silva, Madunil A. Niriella, H. Janaka de Silva
While disposable FFRs, like N95s, are not approved for routine decontamination as a conventional standard of care, FFR decontamination and reuse may be needed during times of shortage to ensure continued availability. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat have been shown to be the most promising of the methods to decontaminate FFRs [47].