The manifestation of a new pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), constitutes a new problem for modern health care systems. Developing updated standards for all emergency services working at an accident site during the pandemic has been a continuous challenge. The principal method of preventing the transmission of the SARS-CoV-2 virus is the use of personal protective equipment, such as protective suits, masks and goggles, or face shields. The study aims to present the recommended on-site procedures during the coronavirus pandemic based on the description of an accident of an ambulance transporting a patient with confirmed SARS-CoV-2 infection, emphasizing the actions taken by the emergency services sent to the accident site.

There are always significant challenges in improving the safety culture by changing and adding additional safety protocols. The unknown impacts of COVID-19 and how it quickly spreads led the industry to institute essential safety protocols. This paper addresses two problem statements. The first problem statement is: what are the additional safety protocols for process safety, construction & maintenance, and personal protective equipment requirements? The second problem statement is: what are the cost and schedule impacts of industrial construction projects resulting from implementing safety protocols and process safety during construction with the added PPE? While complying with added safety protocols, the industrial construction industry cannot forget that it has a distinct reputation for high incident rates and less than desirable safety performance. In 2017, the construction industry suffered 971 fatalities. This alarming number is compared to 1123 total fatalities in 2017 for the Gulf Coast States. The objective is to share the rationale and practices of social distancing, required additional PPE, and personal hygiene practices to reduce spreading and outbreaks during a pandemic within an industrial construction environment. Before any construction work, the process safety teams must clear, isolate, and tag out process lines, equipment, and instruments to be repaired or replaced. The information presented demonstrates the significant cost and schedule impacts that industrial construction companies will encounter during a pandemic like COVID-19. This paper aims to improve safety processes, cost & schedule impacts, and prescribe additional personal protective equipment in industrial construction during a pandemic such as COVID-19. The COVID-19 pandemic spread globally in a very short period. The reactions in mitigating the spread were suggestive, with little to no data on safety protective equipment and practices. The contribution this paper addresses are how to employ efficient safety practices and policies during a pandemic in an industrial construction environment.

There is a paucity of data on risk factors for infection among healthcare workers (HCWs) from India. Our objective was to evaluate the risk factors and frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs.
We conducted this retrospective case-control study of 3100 HCWs between May and July 2020. HCWs positive for SARS-CoV-2 infection were the cases (n=506) and those negative for SARS-CoV-2 were the controls (n=253). Univariate analysis was followed by multivariate analysis of key demographic, clinical and infection control variables.
SARS-CoV-2 infection was found in 16.32% of HCWs. Nearly 45% of infected HCWs were asymptomatic. The proportions of sanitation workers (24% vs 8%; p<0.0001) and technicians (10% vs 4%; p=0.0002) were higher and that of doctors was lower among cases as compared with controls (23% vs 43%; p<0.0001). On univariate analysis, the type of HCW, smoking, lack of training, inadequate personal protective equipment (PPE) use and taking no or fewer doses of hydroxychloroquine (HCQ) were found to be significant. On multivariate analysis, the type of HCW (risk ratio [RR] 1.67 [95% confidence interval {CI} 1.34 to 2.08], p<0.0001), inappropriate PPE use (RR 0.63 [95% CI 0.44 to 0.89], p=0.01) and taking fewer doses of HCQ (RR 0.92 [95% CI 0.86 to 0.99], p=0.03) were significant.
The frequency of SARS-CoV-2 infection was 16% among HCWs. Being a sanitation worker, inappropriate PPE use and lack of HCQ prophylaxis predisposed HCWs to SARS-CoV-2 infection.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has an impact on the delivery of neurosurgical care, and it is changing the perioperative practice worldwide. We present the first case in the literature of craniectomy procedure and asportation of a solitary cerebellar metastasis of the oesophagus squamous carcinoma in a 77 years old woman COVID-19 positive. In these particular circumstances, we show that adequate healthcare resources and risk assessments are essential in the management of COVID-19 patients referred to emergency surgery.
METHODS: The case here presented was treated in 2019 for squamous carcinoma of the oesophagus. In April 2020, she presented a deterioration of her clinical picture consisting of dysphagia, abdominal pain, hyposthenia and ataxia. A Head CT scan was performed, which showed the presence of a solitary cerebellar metastasis. Her associated SARS-CoV-2 positivity status represented the principal clinical concern throughout her hospitalisation.
CONCLUSIONS: The patient underwent a suboccipital craniectomy procedure with metastasis asportation. She tested positive for SARS-CoV-2 in the pre- and post-operative phases, but she was not admitted to the intensive care unit because she did not present any respiratory complications. Her vital parameters and inflammation indexes fell within the reference ranges, and she was kept in isolation for 16 days in our neurosurgical unit following strict COVID-19 measures. She was asymptomatic and not treated for any of the specific and non-specific symptoms of COVID-19.
CONCLUSIONS: This is the first case reported of solitary cerebellar metastasis of oesophagus carcinoma operated on a COVID-19 positive patient. It shows that asymptomatic COVID-19 positive patients can undergo major emergency surgeries without the risk of infecting the operating team if adequate Personal Protection Equipment (PPE) is used. The patient remained asymptomatic and did not develop the disease\'s active phase despite undergoing a stressful event such as a major emergency neurosurgical procedure. In the current crisis, a prophylactic COVID-19 screening test can identify asymptomatic patients undergoing major emergency surgery and adequate resource planning and Personal Protective Equipment (PPE) for healthcare workers can minimise the effect of the COVID-19 pandemic.

We evaluated effectiveness of personal protective measures against severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection. Our case-control study included 211 cases of coronavirus disease (COVID-19) and 839 controls in Thailand. Cases were defined as asymptomatic contacts of COVID-19 patients who later tested positive for SARS-CoV-2; controls were asymptomatic contacts who never tested positive. Wearing masks all the time during contact was independently associated with lower risk for SARS-CoV-2 infection compared with not wearing masks; wearing a mask sometimes during contact did not lower infection risk. We found the type of mask worn was not independently associated with infection and that contacts who always wore masks were more likely to practice social distancing. Maintaining >1 m distance from a person with COVID-19, having close contact for <15 minutes, and frequent handwashing were independently associated with lower risk for infection. Our findings support consistent wearing of masks, handwashing, and social distancing to protect against COVID-19.

The coronavirus disease-2019 (COVID-19) era is a challenging time for respiratory teams to protect their patients and staff. COVID-19 is predominantly transmitted by respiratory droplets; in the clinical setting, aerosol generating procedures pose the greatest risk for COVID-19 transmission. Bronchoscopy is associated with increased risk of patient-to-health care worker transmission, owing to aerosolized viral particles which may be inhaled and also result in environmental contamination of surfaces.
We describe our experience with the use of modified full-face snorkeling masks for pediatric bronchoscopy procedures in four COVID-19 infected children when filtering facepieces/respirators were in limited supply.
Bronchoscopy was urgently required in four children, and could not be delayed until COVID-19 test results were available. During the pandemic peak, when respirators were in short supply, modified full-face snorkel masks (SEAC Libera, SEAC, Italy) were worn by the bronchoscopy team. Each mask was fitted with an O-ring, adapter, and heat and moisture exchanger filter. To date, there have been no COVID-19 infections among the bronchoscopy team staff, whereas the overall Hospital staff COVID-19 prevalence rate has exceeded 13.5% (667/4949).
Emergency bronchoscopy procedures on COVID-19 infected patients or patients with unknown infection status can be safely performed using modified full-face snorkel masks.

Coronavirus (COVID-19) is highly infectious agent that causes fatal respiratory illnesses, which is of great global public health concern. Currently, there is no effective vaccine for tackling this COVID19 pandemic where disease countermeasures rely upon preventing or slowing person-to-person transmission. Specifically, there is increasing efforts to prevent or reduce transmission to front-line healthcare workers (HCW). However, there is growing international concern regarding the shortage in supply chain of critical one-time-use personal and protective equipment (PPE). PPE are heat sensitive and are not, by their manufacturer\'s design, intended for reprocessing. Most conventional sterilization technologies used in hospitals, or in terminal medical device sterilization providers, cannot effectively reprocess PPE due to the nature and severity of sterilization modalities. Contingency planning for PPE stock shortage is important. Solutions in the Republic of Ireland include use of smart communication channels to improve supply chain, bespoke production of PPE to meets gaps, along with least preferred option, use of sterilization or high-level disinfection for PPE reprocessing. Reprocessing PPE must consider material composition, functionality post treatment, along with appropriate disinfection. Following original manufacturer of PPE and regulatory guidance is important. Technologies deployed in the US, and for deployment in the Republic of Ireland, are eco-friendly, namely vaporised hydrogen peroxide (VH2O2), such as for filtering facepiece respirators and UV irradiation and High-level liquid disinfection (Actichlor+) is also been pursed in Ireland. Safeguarding supply chain of PPE will sustain vital healthcare provision and will help reduce mortality.