Sign Iowa Healthcare / Medical Emergency Contact Form Now

Industry sign healthcare medical iowa emergency contact form now

i am ali ward editorial director of contagion joining me today is dr. michael edmond associate chief medical officer chief quality officer and clinical professor of infectious diseases at the university of iowa dr. Edmund and colleagues recently published a viewpoint in JAMA I'm moving personal protective equipment into the community in the form of face shields this piece has been getting a ton of buzz on Twitter from the IG community so dr. Edmund let's dive right in your article asks the question can we reduce covent transmission in the community by universally adopting face shields in addition to existing interventions such as testing contact tracing and hand hygiene so why a face shield so that's a good question we first addressed this inside the hospital this started several weeks ago as we started to look at all of our plans for coated and what we realized was this supply chain for face masks is quite compromised because most of the factories that make face masks medical grade face masks are in China they've been impacted by the outbreak and were shut down so we were concerned that we might not be able to make it through the outbreak having enough face masks and so we started to look at face shields to see if we could get them and what we found is that because they're used in other industries they were available and we were able to source them and bring them into the hospital so within a few weeks we were able to have every person in our Hospital in a facial both those seeing patients and those that are aren't seeing patients and we learned a lot about face shields in in that implementation because we we implemented somewhere between 13 and 15 thousand face shields in a relatively rapid period of time then I started to think about whether this might be something that we could do with the community part of the problem we have again in the community is if we were gonna ask people to wear face masks which week which CDC has now asked them to do again we don't have good supplies of medical-grade face masks and people are there for having wear cloth face masks we know from the medical literature that cloth face masks are inferior to medical grade face masks and so they probably could provide some protection the cloth face mask but but probably not where it needs to be and so we started to think more about whether face shields might be an alternative in the community setting and you touched on it a little bit you can get more intimate what is the benefit of a face shield over face mask we have any evidence that supports the effectiveness so in terms of effectiveness with with this particular virus we don't have an evidence yet I think we can infer from what we know about influenza in which there are simulation studies that show very significant decreases in contamination of a person when when droplets are coming at them when a face shield is being used at about 18 inches so and it's about a 96 percent reduction so it's very very good so and that's only with one face shield a face shield on the receiver end but if everybody is in face shields you have both source control and protection of the susceptible person and so we would envision that the effectiveness would even be better in that situation right you touched a little on the whole production supply chain aspect of this I mean you do hear all about the shortages of medical masks and other PPE so you're saying we wouldn't run into those issues with face shields how can we leverage some of the existing supply chains if we were to universally adopt these so one of the great things that's happened is that a number large manufacturers have been able to retrofit their production lines to produce face shields so for example Apple and Nike John Deere GM they're all now making face shields and there are a host of smaller companies that are doing it as well I even though that's not their normal business they're producing these and selling them so it's actually you know and I keep an eye on this because I have an interest in it it's relatively easy to be able to find a facial if you want to get one right and I guess there's also the thing that they're reusable many advantages and one is the fact that they're durable so a paper mask the standard medical mask has a finite lifespan once they get wet from the exhaled air they lose effectiveness they start to to degenerate so they're not made to last on the other hand a face shield is is a durable piece of equipment because it's primarily made of plastic and the other great thing about it is you can you can clean them in between uses so you can just wash them off a soap and water or any kind of household disinfectant that you might have and another great advantage of them over face masks is that they prevent you from touching your face and one of the things we know about face masks is that some people will begin to touch their face more to try to adjust the mask and that's exactly what we don't want because if your hands are contaminated with the virus then you're going to Auto inoculate yourself essentially touching your nose or your eyes or mouth and give yourself the virus and so the face shield and I've done this firsthand now wearing face shields in the hospital when I'm seeing patients is sometimes your face will it should you go to scratch it and you realize there's a shield there and you can't touch your face so that's one of the great benefits of wearing a face shield I imagine there's also some you know social things to wear you know face shield doesn't impede those interactions as much as a face mask in terms of kind of stifling vocalizations or even covering up expressions right so facial expressions you can still see you can see people's lip movements which helps with speech perception one of the things that my wife who's an oncologist talks about is how difficult it is to have important conversations with patients about prognosis or end-of-life those kinds of things when you're wearing a face mask whether you can't it is a barrier communication so I think the face shield it's a little easier from that standpoint definitely so I guess the million-dollar question is how do we convince people to wear these we seem to have a hard enough time convincing people to practice social distancing yes or even washing their hands right so all of these health-related behaviors I think takes some time I guess it's interesting to me that uh that even though we haven't been dealing with code for that long of a period of time I think people are changing their behaviors you know I can see it every day when I go out to take a run in my neighborhood if there's another runner coming in the opposite direction one of us will cross the street so that we're not close to each other I think you're seeing more people we're wearing some type of face covering when they are going for example to the grocery store and I think they are more cognizant of hand hygiene so I think it's happening but I think with any health related behavior it's it's not something that happens instantaneously it takes a lot of practice for us to be able to do it absolutely do you see society being able to possibly reopen or get to a new normal sooner if we added face shields well that's that's our hypothesis yeah our hypothesis is that if every person were going to face you the transmission of this virus would go down we think we would be able to to decrease the arm not to less than one and in that case we would be able to open up society sooner because we're able to use some other adjunctive means to social distancing to getting that transmissibility down and you know if we were to universally adopt these that could incorporate you know some sort of policy decision from a government standpoint what about convincing you know the government or leaders who can make those types of decision right well I think that the issue now is and I think we're seeing this is the difficulties of doing what we're doing now which is to keep people sheltering in place restricting their movements those are hard things for our society to grapple with if we're able to use something as simple as a face shield to allow society to to relax some of these more difficult things then it might be an easy sell because I think people would see the benefit of that right I'm have you received any feedback on your piece since it was published Boston you know we've received feedback from a lot of people's some people very supportive of it some people concerned about infectious aerosols one of the things we talked about in the viewpoint is that at least at this point the the evidence suggests that the primary mechanism transmission is droplet and not aerosol and of course the face shield is great for droplets it will catch all those droplets on the shield if there's aerosol transmission then the shields wouldn't be as good but again we think by having both the susceptible person and the infectious source in face shields even that aerosol is ation will be markedly decreased and there's nothing to prevent people from putting a mask on underneath with a face shield if they want to do that anyway so I think that the feedback that that we've received as sort of what we've expected we see people on both sides of the argument dr. Edmund is there anything else that you would like to add I don't think so I think we covered it well thank you so much for joining me today and for sharing your insight we really appreciate it thanks a lot