COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury
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The COVID-19 pandemic has introduced a number of added obstacles to safe employment for already-challenged essential workers. Essential workers not employed in the health sector generally include racially diverse, low-wage workers whose jobs require close interaction with the public and/or close proximity to their coworkers, placing them at increased risk of infection. A narrative review facilitated the analyses of health outcome data in these workers and contributing factors to illness related to limited workplace protections and a lack of organizational support. Findings suggest that this already marginalized population may also be at increased risk of "moral injury" due to specific work-related factors, such as limited personal protective equipment (PPE) and the failure of the employer, as the safety and health "duty holder," to protect workers. Evidence suggests that ethical and, in some cases, legally required safety protections benefit not only the individual worker, but an employer's enterprise and the larger community which can retain access to resilient, essential services.Keywords:
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The purpose of this study was to find out problems encountered by Foskor Mine workers in Phalaborwa with the use of personal protective equipment and also to find out how these problems can be prevented or solved. A quantitative research study was done using a questionnaire as a data gathering tool on workers who are exposed to occupational injuries and illnesses and who use personal protective equipment for their protection. The findings revealed that even though workers were using personal protective equipment they still got occupational injuries and illnesses. They also had problems with their protective equipment like incompatible types of personal protective equipment, such as weight where heavy personal protective equipment like boots were issued and very hot or cold personal protective equipment incompatible with the temperature of the environment. Some personal protective equipment like gloves were of a wrong size and caused allergy. In some instances unavailability of or unsuitable personal protective equipment posed challenges to these workers.
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Background: The number of cases infected with COVID-19 continues to increase, so it is very necessary to handle Covid-19 cases. One of them is the use of personal protective equipment (PPE) for corpse recovery officers in handling Covid-19 bodies. The purpose of the study was to analyze the impact of the use of PPE on the Covid-19 corpse recovery officers at the Macanda Gowa Cemetery.
Methods: This research is qualitative research with a phenomenological approach. The number of research is 5 main informants, 2 supporting informants, and 1 key informant.
Results: The results of this study showed that the behavior of the mortuary officers was anxious, afraid, worried, had experience in handling Covid-19 corpses, wore personal protective equipment (PPE) for 2-3 hours, burned PPE, removed PPE at the specified location, size The PPE is not suitable for the Covid-19 relocation officer. The impacts of PPE are heat, heat, skin injuries, headaches, dehydration, hot skin (prickly heat), fever, Covid-19 positive, difficulty breathing. Managing the negative impact of using PPE by turning on the air conditioning (AC), opening the windshield, unzipping the hazmat shirt a little, and removing the mask and face shield, smearing the body with eucalyptus oil, cleaning the body, drinking water and exercising.
Conclusions and suggestions: The behavior of the Covid-19 corpse recovery officer in using PPE does not comply with the use of personal protective equipment correctly. This is due to the lack of knowledge of the mortuary staff regarding the proper use of PPE. So that the effects of PPE are not correct. There is a need for supervision and awareness-raising on the understanding of the use of PPE for COVID-19 corpses.
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Background Correct use of personal protective equipment is vital to minimise the risk of patients acquiring healthcare-associated infections. These measures are also important in preventing exposure to occupational infection. During the COVID-19 pandemic, the use of personal protective equipment was associated with anxiety, uncertainty and additional training requirements. This study investigated midwives’ experiences using personal protective equipment during the pandemic. Methods This systematic scoping review searched seven academic databases and grey literature. Data analysis was conducted using a thematic analysis framework. Results A total of 16 studies were included. Four themes were found: ‘fear and anxiety’, ‘personal protective equipment/resources’, ‘education and training needs’ and ‘communication’. Conclusions Management and administration inconsistences, logistical issues and lack of training on personal protective equipment led to midwives’ negative feedback. A gap has been identified in the exploration of midwives’ experiences as personal protective equipment end-users during the COVID-19 pandemic.
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To the Editor: There have been an increasing number of reports of occupationally induced skin conditions in health care workers related to the use of personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic.1Gheisari M, Araghi F, Moravvej H, et al. Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic [e-pub ahead of print]. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16492. Accessed May 7, 2020.Google Scholar,2Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar The breadth and variety of different types of PPE, such as facemasks, gloves, and respiratory equipment, as well as the extended use beyond previous standards, have led to a spectrum of common dermatologic conditions, including contact/irritant dermatitis, pressure-related skin injury, acneiform eruptions, and moisture-associated skin irritation (Table I).Table ISkin condition related to masks—treatment and prevention strategiesSkin conditionSurgical maskN95 maskContact/irritant dermatitisUse alcohol-free barrier film wipe behind the ears before wearing, orApply thin foam dressing behind the ear beneath ear loop of surgical mask.N95 mask straps should be worn on the crown of the head, so should not be sitting on top of the ears.Pressure-related skin injuryApply thin foam dressing behind the ears beneath ear loop of surgical mask.Prophylactic dressings can be used under surgical masks for treatment/prevention. Proposed materials include a thin hydrocolloid dressing or thin foam dressing. Cut/adjust material to application site and apply dressing to skin without tension. Once PPE is removed at end of shift, wash hands, don clean gloves, gently remove dressings, and wash hands again. When removing prophylactic dressings, close eyes and avoid inhaling any aerosolized virus or particles.Apply alcohol-free barrier film wipe (not spray) on areas of direct PPE contact (eg, nose, cheeks, forehead, behind the ears) to protect skin from moisture and friction. Before applying, ensure the area is free of make-up, etc. Do not apply to eyes or eyelids. Allow to dry for 90 seconds before donning PPE.Wear facial PPE correctly and make sure size is correct.If skin damage is present, consider applying petrolatum to open areas 3-4 times a day when away from work. If an open area of skin is present, a hydrocolloid dressing may be used to help it heal; however, using these dressings under N95 masks requires refit testing to ensure adequate seal.AcneWash your face with gentle, mild fragrance free, noncomedogenic cleanser in the morning and at the end of the day. Take appropriate breaks from the mask: 15 minutes off every 2 hours.Wash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day.Take appropriate breaks from the mask: 15 minutes off every 2 hours.Moisture- associated skin irritationWash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day. Take appropriate breaks from the mask: 15 minutes off every 2 hours.Wash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day.Take appropriate breaks from the mask: 15 minutes off every 2 hours—if safe and practical to do so.PPE, Personal protective equipment. Open table in a new tab PPE, Personal protective equipment. Surgical and N95 masks, as well as goggles and face shields, have been reported to cause contact dermatitis, typically behind the ears (from elastic straps), on the bridge of the nose, or rarely on the entire face. Mask-induced contact dermatitis and contact urticaria can occur due to adhesives, rubber in straps, free formaldehyde released from the nonwoven polypropylene, and from metals in clips.3Foo C. Goon A.T. Leow Y.H. et al.Adverse skin reactions to personal protective equipment against severe acute severe acute respiratory syndrome-a descriptive study in Singapore.Contact Dermatitis. 2006; 55: 291-294Crossref PubMed Scopus (227) Google Scholar,4Donovan J. Kudla I. Holness L. et al.Skin reactions following use of N95 facial masks.Dermatitis. 2007; 18: 104Crossref Google Scholar The tighter and more secure N95 masks can cause significant skin damage due to pressure on anatomic points such as the bridge of the nose and across the zygoma. Moisture can accumulate under either type of facemask and predispose to skin breakdown and, potentially, superinfection. Facial PPE should be adjusted to fit correctly and should not lead to excess pressure or discomfort on any one particular area of the face. Skin should be routinely cleaned and moisturized using noncomedogenic emollients at least 1 hour before using facial PPE. Petrolatum-based products are not recommended as a skin sealing or repair agent because they may interfere with the integrity of the mask itself, in particular, the N95.5National Pressure Injury Advisory Panel (NPIAP)NPIAP position statements on preventing injury with N95 masks.https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdfDate: 2020Date accessed: May 7, 2020Google Scholar According to the Centers for Diseases Control and Prevention, contact dermatitis accounts for 10% to 15% of all health care occupational illnesses. Glove-related allergic contact dermatitis is relatively common in health care workers. The most common causes are rubber accelerators used in the manufacturing of gloves. Skin manifestations include pruritus, erythema, scale, vesicles, and in prolonged cases, hyperpigmentation and lichenification. Health care workers should be encouraged to use moisturizers frequently, especially when not in direct patient care, and ensure hands are clean and dry before the use of gloves and other PPE during patient contact time. For more severe cases of contact dermatitis, topical corticosteroids and other prescription therapies may be warranted. In addition to masks, gloves, and respirators, the repetitive and prolonged use of sterilizing agents, including hand soaps, detergents, and repeated exposure to water, can lead to irritated skin and an increased risk for contact sensitization. To reduce this risk, especially after handwashing, emollients with ceramides or petrolatum, or both, may be beneficial.6Beiu C. Mihai M. Popa L. et al.Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips.Cureus. 2020; 12: e7506PubMed Google Scholar As health care workers, we are ultimately responsible for protecting our patients, ourselves, and the broader community. Wearing PPE for extended periods, as has occurred in the era of COVID-19, can have potentially serious consequences for health care workers. Recognizing occupationally induced skin conditions from PPE, and which of these can be prevented or minimized with proper measures, is critical to help mitigate long-term skin sequelae and maintain compliance. We would like to thank staff at the American Academy of Dermatology for their logistical and administrative support. We would also like to thank, in particular, Theresa Carbone, BSN, RN, CWOCN, William Falone, MSN, RN, CWON, and Shawn Parsons, MSN, CRNP, CWON, along with the Penn Medicine Wound Care Nursing Collaborative, for their ongoing efforts to educate health care workers and the public on the occupational risks in the era of COVID-19.
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Isolation requirements and subsequent need for personal protective equipment (PPE) are among the many challenges associated with the COVID-19 pandemic. Isolation of COVID-19–positive patients and the use of appropriate PPE by health care professionals are important parts of infection prevention, not only in the hospital setting but also in preventing community spread of the disease. This article addresses isolation requirements, appropriate PPE use, and strategies to overcome challenges such as PPE shortage.
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Rationale: Healthcare workers in the ongoing COVID-19 pandemic are faced with too many challenges, including looking after their personal safety and survival. Hydration and food intake can be difficult when wearing the strict full personal protective equipment (PPE) on top of the heat leading to potential dehydration among frontliners. Addressing this concern led to this quick online survey among health professionals in the Philippines. Methods: This survey made use of the Google Forms as a platform between April and May 2020 Results: Of the 105 respondents, majority were physicians (60%), followed by nurses (27%). Most were from private practice (63%), and majority benefited from various donations of PPE (80%). Most wore PPE including coveralls more than thrice a week, and most complained of severe heat with a few experiencing near collapse. 62% were only able to eat after duty hours which can take up to 12 hours of strict contamination safety procedures while a remaining number are still able to take in fluids prior to donning, less than 50% are able to consume 500-1000ml liquids per shift. Nearly 70% are able to take in multivitamin supplementation but only 52% are able to consume balanced nutritious meals according to the survey. Conclusion: Adequate nutrient intake, including fluid hydration, can be compromised when on full PPE while working in COVID-19 wards. References: ·Centers for Disease Control and Prevention. Strategies to Optimize the Supply of PPE and Equipment. Available from: www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html ·Department of Health COVID-19 Updates. www.doh.gov.ph ·How to Conserve your PPE during the Coronavirus Pandemic. Available from: www.healthleadersmedia.com/clinical-care/ Christopher Cheney·World Health Organization. Rational Use of Personal Protective Equipment for Coronavirus disease (COVID-19) and considerations during severe shortages. Available from: www.who.int Accessed April 6 2020. Disclosure of Interest: None declared.
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Personal Protective Equipment and Covid-19 This video demonstrates a procedure for donning and doffing one type of PPE recommended by the CDC for use in hospitals to minimize the risk of exposure t...
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Abstract Several interpreters argue that Kant believes we have a duty to act “from duty.” If there is such a duty, however, then Kant's moral theory faces a serious problem, namely that of an allegedly vicious infinite regress of duties. No serious attempt has been made to determine how Kant might respond to this problem and insufficient work has been done to determine whether he even believes we have a duty to act from duty. In this paper I argue that not only does Kant not hold that there is a duty to act from duty, but he also explicitly rejects the idea.
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