COVID-19: Akzeptanz und Compliance von persönlicher Schutzausrüstung (PSA) und AHA-L-Regeln (Abstands- und Hygieneregeln) im deutschen Rettungsdienst – eine bundesweite Umfrage  <span class="so-article-trans-title" dir="auto"> Translated title: COVID-19: acceptance and compliance of PPE (personal protective equipment) and rules for hygiene and reducing contacts in German emergency medical services—a nationwide survey </span>

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Abstract

Hintergrund

Die COVID-19-Pandemie (coronavirus disease-2019) hat auch den deutschen Rettungsdienst deutlich belastet und gefordert. Die persönliche Schutzausrüstung (PSA) und die AHA-L-Regel (Abstand halten, Hygiene beachten, Maske tragen, regelmäßig lüften) spielen hierbei eine wichtige Rolle, um eine Verbreitung der COVID-19-Infektionen zu reduzieren.

Ziel

Mit dieser Studie möchten wir die Akzeptanz und Compliance von PSA und Schutzmaßnahmen beim Rettungsdienstpersonal in Deutschland in Pandemiezeiten evaluieren.

Methode

Über 270 ÄLRD wurden angeschrieben. Diese wurden gebeten, eine webbasierte Onlineumfrage an die Rettungswachen weiterzuleiten. Die Teilnehmer wurden zu Akzeptanz und Compliance im Alltag, in der Rettungswache, im Einsatz ohne COVID-19, im Einsatz mit COVID-19 befragt.

Ergebnisse

Es haben n = 1295 Personen teilgenommen. Die Akzeptanz und Compliance von PSA und Schutzmaßnahmen ist insgesamt hoch. Die geringste Akzeptanz und Compliance findet sich bei den Fragen Akzeptanz (MW = 4,16; ±1,01) und Compliance (MW = 4,26; ±0,89) in der Rettungswache.

Fazit

Wir empfehlen gezielte Schulungsmaßnahmen in Bezug auf PSA in Pandemien und die Bereitstellung von entsprechenden Räumlichkeiten zur konfliktlosen Einhaltung der AHA-L-Regeln.

Translated abstract

Background

The coronavirus disease 2019 (COVID-19) pandemic has also significantly burdened and challenged the German emergency medical services (EMS). In this regard, the personal protective equipment (PPE) and rules like wear a mask, stay 6 feet away from others, avoid crowds and poorly ventilated spaces, wash your hands often (called AHA‑L rules in Germany) play an important role in reducing the spread of COVID-19 infections.

Objective

The aim of this study is to evaluate the acceptance and compliance of PPE and protective measures among rescue service personnel in Germany during pandemic periods.

Method

More than 270 medical directors of EMS were contacted. They were asked to forward a web-based online survey to the rescue stations. Participants were asked about acceptance and compliance in everyday life, in the rescue station, during missions without COVID-19, during missions with COVID-19.

Results

There were n = 1295 participants. Overall acceptance and compliance of PPE and protective measures is high. The lowest acceptance and compliance is found in the questions acceptance (mean = 4.16; ±1.01) and compliance (mean = 4.26; ±0.89) in the rescue station.

Conclusion

We recommend targeted training regarding PPE in pandemics and the provision of appropriate premises for conflict-free compliance with AHA‑L rules.

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Most cited references 22

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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A new coronavirus associated with human respiratory disease in China

Fan Wu, Su Zhao, Bin Yu … (2020)

Emerging infectious diseases, such as severe acute respiratory syndrome (SARS) and Zika virus disease, present a major threat to public health 1–3 . Despite intense research efforts, how, when and where new diseases appear are still a source of considerable uncertainty. A severe respiratory disease was recently reported in Wuhan, Hubei province, China. As of 25 January 2020, at least 1,975 cases had been reported since the first patient was hospitalized on 12 December 2019. Epidemiological investigations have suggested that the outbreak was associated with a seafood market in Wuhan. Here we study a single patient who was a worker at the market and who was admitted to the Central Hospital of Wuhan on 26 December 2019 while experiencing a severe respiratory syndrome that included fever, dizziness and a cough. Metagenomic RNA sequencing 4 of a sample of bronchoalveolar lavage fluid from the patient identified a new RNA virus strain from the family Coronaviridae, which is designated here ‘WH-Human 1’ coronavirus (and has also been referred to as ‘2019-nCoV’). Phylogenetic analysis of the complete viral genome (29,903 nucleotides) revealed that the virus was most closely related (89.1% nucleotide similarity) to a group of SARS-like coronaviruses (genus Betacoronavirus, subgenus Sarbecovirus) that had previously been found in bats in China 5 . This outbreak highlights the ongoing ability of viral spill-over from animals to cause severe disease in humans.

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Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Neeltje van Doremalen, Trenton Bushmaker, Dylan H Morris … (2021)

To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. 1 We analyzed the aerosol and surface stability of SARS-CoV-2 and compared it with SARS-CoV-1, the most closely related human coronavirus. 2 We evaluated the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated their decay rates using a Bayesian regression model (see the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) and SARS-CoV-1 Tor2 (AY274119.3) were the strains used. Aerosols (<5 μm) containing SARS-CoV-2 (105.25 50% tissue-culture infectious dose [TCID50] per milliliter) or SARS-CoV-1 (106.75-7.00 TCID50 per milliliter) were generated with the use of a three-jet Collison nebulizer and fed into a Goldberg drum to create an aerosolized environment. The inoculum resulted in cycle-threshold values between 20 and 22, similar to those observed in samples obtained from the upper and lower respiratory tract in humans. Our data consisted of 10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard). All experimental measurements are reported as means across three replicates. SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A). SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). Both viruses had an exponential decay in virus titer across all experimental conditions, as indicated by a linear decrease in the log10TCID50 per liter of air or milliliter of medium over time (Figure 1B). The half-lives of SARS-CoV-2 and SARS-CoV-1 were similar in aerosols, with median estimates of approximately 1.1 to 1.2 hours and 95% credible intervals of 0.64 to 2.64 for SARS-CoV-2 and 0.78 to 2.43 for SARS-CoV-1 (Figure 1C, and Table S1 in the Supplementary Appendix). The half-lives of the two viruses were also similar on copper. On cardboard, the half-life of SARS-CoV-2 was longer than that of SARS-CoV-1. The longest viability of both viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic (Figure 1C). Estimated differences in the half-lives of the two viruses were small except for those on cardboard (Figure 1C). Individual replicate data were noticeably “noisier” (i.e., there was more variation in the experiment, resulting in a larger standard error) for cardboard than for other surfaces (Fig. S1 through S5), so we advise caution in interpreting this result. We found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested. This indicates that differences in the epidemiologic characteristics of these viruses probably arise from other factors, including high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 3,4 Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, 5 and they provide information for pandemic mitigation efforts.

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Author and article information

Contributors

André Nohl: andre.nohl@oberhausen.de

Journal

Journal ID (nlm-ta): Notf Rett Med

Journal ID (iso-abbrev): Notf Rett Med

Title: Notfall & Rettungsmedizin

Publisher: Springer Medizin (Heidelberg )

ISSN (Print): 1434-6222

ISSN (Electronic): 1436-0578

Publication date (Electronic): 16 July 2021

Pages: 1-8

Affiliations

[1 ]Ärztliche Leitung Rettungsdienst, Stabsstelle Rettungsdienst, Berufsfeuerwehr Oberhausen, Brücktorstraße 30, 46047 Oberhausen, Deutschland

[2 ]GRID grid.491667.b, ISNI 0000 0004 0558 376X, Zentrum für Notfallmedizin, , BG Klinikum Duisburg, ; Duisburg, Deutschland

[3 ]GRID grid.506180.a, Klinik für Anästhesiologie und Intensivmedizin, , Evangelisches Krankenhaus Oberhausen, ; Oberhausen, Deutschland

[4 ]GRID grid.410718.b, ISNI 0000 0001 0262 7331, Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, , Universitätsklinikum Essen, ; Essen, Deutschland

[5 ]Ärztliche Leitung Rettungsdienst, Berufsfeuerwehr Essen, Essen, Deutschland

[6 ]Ärztliche Leitung Rettungsdienst, Berufsfeuerwehr Duisburg, Duisburg, Deutschland

[7 ]Luftrettungszentrum Christoph 9, Duisburg, Deutschland

[8 ]GRID grid.491667.b, ISNI 0000 0004 0558 376X, Klinik für Orthopädie und Unfallchirurgie, , BG Klinikum Duisburg, ; Duisburg, Deutschland

[9 ]GRID grid.491667.b, ISNI 0000 0004 0558 376X, Klinik für Anästhesiologie und Intensivmedizin, , BG Klinikum Duisburg, ; Duisburg, Deutschland

Article

Publisher ID: 925

DOI: 10.1007/s10049-021-00925-6

PMC ID: 8284034

SO-VID: 22395681-ab68-4159-b8a4-9a91f7516ee2

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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Abstract

Hintergrund

Ziel

Methode

Ergebnisse

Fazit

Translated abstract

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Novel Coronavirus Disease COVID-19

Most cited references 22

A Novel Coronavirus from Patients with Pneumonia in China, 2019

A new coronavirus associated with human respiratory disease in China

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

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