Respirator fit of a medium mask on a group of South Africans: a cross-sectional study

http://www.ehjournal.net/content/10/1/17

Background: In South Africa, respiratory protective equipment is often the primary control method used to protect workers. This preliminary study investigated how well a common disposable P2 respirator fitted persons with a range of facial dimensions. Methods: Quantitative respirator fit tests were performed on 29 volunteers from different racial, gender and face size groups. Two facial dimensions width (bizygomatic) and length (menton-sellion) were measured for all participants. Results: In this study 13.8% of the participants demonstrated a successful fit with the medium sized mask. These included participants from three different racial and both gender groups. The large percentage of failed fit tests (86%) indicates that reliance on off-the-shelf respirators could be problematic in South Africa. Conclusions: The limitations of this preliminary study notwithstanding, respirator fit appear to be associated with individual facial characteristics and are not specific to racial/ethnic or gender characteristics.

This is one reason why I think the Totobobo mask is so useful. It is much easier to modify the mask to fit different faces. The Totobobo mask really needs to be tested in a place like Alaska where we have faces from many different populations. See the Flickr set at Respirators masks for pandemics, volcanoes, dust, woodworking, cycling

Primary entry about respirators is Masks — Types, Choosing (PPE)

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Technorati Tags: masks, respirators, PPE, preparedness, Totobobo, anthropometry

Some costs of not using the Alaska PFD and leading by example

Andrew Halcro last week wrote a succinct piece on an all too common tragedy in Alaska and New Mexico.

At first glance it had all the makings of a Hollywood movie set. But this was no Hollywood movie set, it was my front yard on Sand Lake and it was 3am on June 10. For two days, fire and police vehicles were fixtures in my front yard, as the search for a missing canoeist continued. Family members gathered outside my front window, watching and waiting as they held hands, cried and prayed….

One APD officer on the scene told me that these kinds of tragedies are all too frequently due to an unfortunate combination of events. … In this case, the costliest hole was when the two young men launched their canoe at the public access point, they walked right past a newly erected life jacket stand that offered boaters free personal flotations devices.

Alaska initiated the “Kids Don’t Float” program. Fireman Bob Painter of Homer founded the program after a number of children drowned in Homer.

(May 29, 2009, Anchorage, Alaska) – The “Kids Don’t Float” and boating safety programs will continue this summer… Under these boating safety programs, children learn about boating safety in schools, and life jackets are available for loan at many lakes and rivers across Alaska. …Representative Mark Neuman of Wasilla sponsored HB 151 and Governor Palin signed the legislation in May.

Both NM and Alaska rank high in the USA for the prevalence of drownings (the number of deaths divided by the population). Alaska is a semi-arid region with a lot of riparian and coast line; New Mexico is a semi-arid region. Both states share a cultural norm that things go better with alcohol, especially if activities involve an engine (boat, auto, snowmachine). Both states seem to believe “accidents” [not my fault] are always happening but ones with bad consequences only happen to others, the less deserving.

PFDs (personal flotation devices, once referred to as lifevests) are no substitute for sobriety but they can buy time, if properly used. Even without alcohol present, PFDs are valuable. Take a look at these numbers–

http://dnr.alaska.gov/parks/boating/pdf/kdfschool08.pdf
1. Alaska has one of the highest boating fatality rates in the nation
a. at least 6 out of 10 are NOT wearing a life jacket
b. 9 out of 10 involve boats 26 feet and under
c. 5 out of 6 are due to capsizing or falling overboard
d. 8 out of 10 are Alaska residents
e. 9 out of 10 are adult males
f. at least 1 out of 3 involve alcohol
g. nearly all incidents involve cold water immersion

The state law allows adults to endanger themselves, but not underage children.

5. Legal requirements
a. everyone in the boat must have a life jacket of the proper size readily accessible
b. anyone under the age of 13 must be wearing a life jacket when on deck or in an open boat
c. must be suitable for the activity and wearer
1. read the label
d. must be in serviceable condition
1. free of defects (tears, missing zippers, broken buckles)
e. must be USCG-approved

A child’s coloring book encourages children to grow up to remember the law’s requirements.
from http://dnr.alaska.gov/parks/boating/pdf/2006ColoringBook36pgWEB.pdf

PARENTS:
It’s the LAW!
Persons under the age of thirteen
MUST wear their
PFD in an open boat
or on a deck.

Alaskan 8-year old on open boat without PFD

Gov. Sarah Palin issued this proclamation in May to remind all of us that being safe around water, whether or not boating or fishing, is smart and more than the easily remembered “do what you otter around water, wear a pfd”

“WHEREAS, Alaska is blessed with an extensive coastline, millions of lakes, and thousands of rivers, making Alaska’s waters an important part of daily life; and

WHEREAS, our state offers many diverse boating opportunities for transportation, subsistence, and recreation, including kayaking, canoeing, rafting, and power boating; and

WHEREAS, boating can also be dangerous, and often fatal; and

WHEREAS, Alaska’s frigid waters can kill the unprepared, regardless of swimming ability; and

WHEREAS, four out of five of Alaska’s boating fatalities involve a sudden, unexpected capsize or fall overboard; and

WHEREAS, to help prevent accidents or fatalities while boating, boaters can take the simple step of wearing life jackets when in an open boat or on an open boat deck. In an emergency, life jackets provide an important advantage, and allow all efforts to be focused on self-rescue or getting help from others; and

WHEREAS, the newest designs make today’s life jackets more comfortable, functional, and affordable than ever. There is no reason to not wear one; and

WHEREAS, by wearing life jackets while boating, Alaskans demonstrate that when enjoying the outdoors, safety always comes first;

NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim May 16-22, 2009 as:

Safe Boating Week

in Alaska, and encourage all boaters to make their boating memories this season good ones by always wearing life jackets, carefully preparing for each trip, carrying appropriate communications and signaling devices, and by serving as a positive example on the water for other boaters.
Dated: May 7, 2009
http://www.gov.state.ak.us/proclamations.php?id=1835

To test a life jacket, lift it at the shoulders. If the life jacket comes up over the ears, it is too big.

Test Alaska child's PFD fit. Will she slip out of unzipped PFD on open boat?

Today comes this tragic reminder of the example set “on the water for other boaters.”

A 56-year-old man drowned in Bristol Bay this morning, the Coast Guard said. He was fishing in an 18-foot skiff with his two teenage daughters when he went overboard while pulling in a net, said Coast Guard spokeswoman Sara Francis. … The accident happened in Togiak Bay around 9 a.m. and a nearby fisherman immediately called for Coast Guard help. The skiff was only 10 to 20 yards from shore but the man was not wearing a life jacket.

http://www.adn.com/money/industries/fishing/story/863256.html

2009-08-11 Very nice picture guide to Alaska Safe Boating Course.

Mahalo!

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Site Search Tags: PFD, Bristol+Bay, children, law, drowning, safety, Palin, preparedness, Kids+Don’t+Float, NM, Alaska

How to avoid swine flu H1N1, or any other, quick list

Just visited western Massachusetts, Amherst area. None of the stores (including Whole Foods) and doctors’ offices, medical centers, or retirement places that I saw had any hand sanitizer available for visitors. It doesn’t take much to provide a safe reminder about hand washing and sneezing. See also, Mr Purell goes to City Hall

• My 3 things everyone should know to prevent pandemic flu
• Masks — Types, Choosing (PPE)
• Disinfectants for camp, field, and household
• Song in Yup’ik to time handwashing
• Song to time hand washing for hygiene and disease prevention
• Kung-fu-choo Do it in your sleeve
• ==> Hands washing, sanitizers
• New employer business preparedness resource

2009-05-18
Another source of information about preparedness (in multiple languages), How the 1918 flu prepares for 21st Century, in a comic book

New scientific summary of flu transmission and protection

Influenza and Personal Protective Respiratory Equipment

The Council of Canadian Academies was asked by the Government of Canada to undertake an assessment on the modes of transmission of influenza and the contribution of respirators or surgical masks towards inhibiting the spread of the virus.

Question: How and where is influenza (both seasonal and pandemic) transmitted? Based on the conclusions of this review, what is the contribution that N95 respirators or surgical masks will make in the prevention of transmission of influenza?

in pdf file format
The Complete Report (0.98 mb)
Report in Focus (235 kb)
News Release (102 kb)

• http://scienceadvice.ca/influenza.html

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Site Search Tags: PPE, masks, Canada, review, influenza, sneeze, handwashing, business

CDC guideline for hand hygiene in health-care settings

I’m not sure how I missed this reference. It appeared in the Morbidity Mortality Weekly Report Recommendations and Reports, October 25, 2002 / 51(RR16);1-44 They provide a glossary, an interesting historical summary, a precís of skin, evaluation of behavioral changes, and more.

Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force, Prepared by John M. Boyce, M.D., Didier Pittet, M.D.

• http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231–43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

Part I. Review of the Scientific Data Regarding Hand Hygiene
Historical Perspective
Normal Bacterial Skin Flora
Physiology of Normal Skin
Definition of Terms
Evidence of Transmission of Pathogens on Hands
Models of Hand Transmission
Relation of Hand Hygiene and Acquisition of Health-Care–Associated Pathogens
Methods Used To Evaluate the Efficacy of Hand-Hygiene Products
Review of Preparations Used for Hand Hygiene
Irritant Contact Dermatitis Resulting from Hand-Hygiene Measures
Factors To Consider When Selecting Hand-Hygiene Products
Hand-Hygiene Practices Among HCWs [health care workers]
Adherence factors
Lessons Learned from Behavioral Theories
Methods Used To Promote Improved Hand Hygiene
Other Policies Related to Hand Hygiene (fingernails, gloves, jewelery)
Web-Based Hand-Hygiene Resources
Part II. Recommendations
Part III. Performance Indicators
References

see also
Hands washing, sanitizers
Song to time hand washing for hygiene and disease prevention
Clean Hands Week: How will you celebrate?
Give germs the boot, not our babies: unwashed hands make everyone sick

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Site Search Tags: MMWR, hands, handwashing, hygiene, health+care, soap, antiseptic, CDC, gels, sanitizer, Purell, triclosan, skin, research, gloves, glossary

Dirty Jobs in Bethel, goose butts

[revised]
I don’t have cable or satellite (one of the few) so I’ll try to see this at a friend’s house. He came out this spring to do some of the H5N1 bird flu or avian influenza monitoring in the Kuskokwim Delta (Yukon Delta National Wildlife Refuge, http://yukondelta.fws.gov/ Unfortunately, none of the links work there, except to download a map in pdf and neither do most links at http://alaska.fws.gov/index.htm )

Let’s see if he uses PPE, photo here
Experts will test birds for signs of avian flu or see photo here, Swans and planes

Other resources, Sampling Bird Cloaca or Results Birds and Influenza from Asia into Alaska with map

The show’s website is atrocious, too much flash and no information– here’s the entirety.

Aug 28, 9:00 pm, Discovery Channel (60 minutes)

Dirty Jobs: Wild Goose Chase

Mike Rowe goes on a wild goose chase literally! After traveling to the tundra, Mike joins forces with a team of workers that round up a flock of wild geese with airplanes.

http://dsc.discovery.com/tv-schedules/series.html?paid=1.13949.25321.4062.53

REVISED–
here’s the locator map for Chevak, courtesy of the Alaska DCED/DCRA department (see sidebar. For more info on the Village of Chevak, go to the database of Alaska communities).
additional resources for Chevak area (or use the site search tags below)
http://www.alaskool.org/projects/chevak/chevak/LessonI.html
See additional resources in the comments.

Another map of this year’s sampling locations is here, but the colors and size are too indistinct. It gives better idea of the local relief, however. I don’t know which goose was on world-wide TV.

• http://alaska.usgs.gov/science/biology/avian_influenza/07sampling_locations_20-38.html

Add this to Bookmarks:

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Site Search Tags: Kuskokwim, Dirty+Jobs, geese, cloaca, sampling, Yukon+Delta, Chevak, revised

Cancer vaccine update

2008-11-08 State limits access to 2 free vaccines
http://www.adn.com/life/health/story/581569.html

For the first time in more than 30 years, the State of Alaska will no longer offer all vaccinations free to all Alaska schoolchildren, the state Division of Epidemiology reported this week. [HPV and bacterial meningitis]

Today’s news–

State-supplied Vaccine Available for Women Aged 9–18 Years
Due to an increase in federal funding, the Alaska Immunization Program is now able to provide HPV vaccine for all females aged 9–18 years. This represents a change from a previous Bulletin announcement.4 Furthermore, individual patient screening to determine eligibility for the federal Vaccines for Children (VFC) Program will not be required.

Background
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Most infections with HPV are asymptomatic and self-limited. However, a small proportion of infections become persistent and can lead to cervical cancer in women or other anogenital cancers and genital warts in both men and women. The burden of HPV in the United States is substantial

Efficacy
Vaccine efficacy has been shown to be 100% for prevention of HPV types 16 and 18 related cervical intraepithelial neoplasia (CIN).1 Efficacy is 99% for prevention of external genital lesions caused by all HPV vaccine types…. The use of HPV vaccine does not eliminate the need for Pap test screening, since 30% of cervical cancers are caused by HPV types not included in the vaccine.

Still not recommended for US boys and men (other countries, yes). View: Cancer vaccine now available

Quadrivalent Human Papillomavirus Vaccine Now Available through the Alaska Immunization Program June 4, 2007

http://www.epi.alaska.gov/bulletins/docs/b2007_22.pdf

Eligibility Criteria for Using Vaccines Currently Supplied by the Alaska Immunization Program — May, 2007 June 4, 2007
http://www.epi.alaska.gov/bulletins/docs/b2007_23.pdf

Add this to Bookmarks:

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Site Search Tags: Gardasil, HPV, cancer, vaccine, epidemiology, Alaska, HHS, immunize, immunization, condom, safe sex

Mr Purell, City Clerk

I found Mr Purell at the Bethel City Clerk’s office, a great idea, Sandra. Someone is thinking of others! and practicing preparedness. [and reading | New employer business preparedness resource |/]

• http://cityofbethel.org

GoJo PURELL Pal Desk Holder

• http://workplace.gojo.com/products/index.asp

is available from stationers and office products catalogs, as well as Amazon.com

The easily available hand sanitizer (and his eye-grabbing blue shoes) serves as a reminder to wash hands to avoid spreading germs to others.

They make a couple of other desktop holders and several bulk containers for public places. Check their website for brochures and posters,

• http://workplace.gojo.com/resources/handouts_posters.asp

[But really, the best resource for | posters | etc. is here]

Add this to Bookmarks:

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Site Search Tags: posters, handouts, Purell, hand+sanitizer, city+hall, Bethel

Cancer vaccine now available

speaking of My 3 things everyone should know to prevent bird flu

The Section of Epidemiology Bulletin, State of Alaska released today announces the good news that the vaccine against the virus causing some cancers, disfigurement, and childlessness will be available from the Vaccines for Children Program.

VFC Eligibility Criteria
Vaccines for Children (VFC) is a federal entitlement program that pays for vaccines for children aged 18 years or younger who meet at least one of the following eligibility criteria:
• Medicaid eligible;
• Alaska Native or American Indian;
• Uninsured;
• Underinsured, i.e., has insurance but it does not cover the cost of vaccines, and receiving services at a Federally Qualified Health Center (FQHC).

The bad news is that only girls are mentioned as recipients even though boys are also eligible for the vaccine program.

It is very important that boys and girls both get the vaccine. Men and boys do suffer maiming and illness from this virus. Aren’t they also worthy of protection?

As the NHS Blog Doctor

• http://nhsblogdoc.blogspot.com/2006/10/warts-and-all.htm

points out, “… if you want to protect your teenage daughters against this, or this and your teenage sons against this, I would get them the immunisation as soon as it becomes available.” [The links are to medical teaching sites and pathology images.]

The vaccine is to protect all children, not just some. Contact your legislators or E-mail the Governor to be sure your grandsons and sons are also protected, starting June 2007.

• http://www.epi.alaska.gov/bulletins/docs/b2007_11.pdf

2007-04-10 The manager of the Alaska Immunization Program, Laurel Wood, has kindly informed me that boys cannot be included for vaccination because the US Federal Drug Administration has not licensed it for boys and young men in the United States.

Currently the FDA has approved Gardasil for use only in females. (See question #11 at the FDA website: http://www.fda.gov/cber/products/hpvmer060806qa.htm)
This is based on the data currently available to support the safety and efficacy of the vaccine. Additional testing is being conducted to establish this information for males. If this vaccine receives FDA licensure for use in boys, we will begin to provide it through the same Vaccines for Children Program discussed in the Epidemiology Bulletin.

However, in 2006, the 25 countries of the European Union, including the five largest which are France, Germany, Italy, Spain and the United Kingdom, have approved the vaccine as safe and effective for boys, as well.

In New Zealand, http://www.moh.govt.nz/moh.nsf/pagesmh/4993?Open

# Gardasil is indicated in females aged 9 to 26 years for the prevention of cervical, vulva and vaginal cancer, precancerous or dysplastic lesions, genital warts and infection caused by Human Papillomavirus (HPV) types 6, 11, 16 and 18 (which are included in the vaccine.)

# Gardasil is indicated in males 9 to 15 years for the prevention of infection caused by Human Papillomavirus (HPV) types 6, 11, 16 and 18.

Maybe Sen. Murkowski and Sen. Stevens should be contacted.

Add this to Bookmarks:

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Site Search Tags: HPV, STDs, vaccine, safe+sex, children, NHSBlogDoc, cancer, Lisa+Murkowski, Ted+Stevens

Villagers living in bird flu’s flight path

The story is not timely. However, it is good to be reminded that the possibility of pandemic influenza (highly pathogenic avian influenza) still exists. For us, it is still good to be reminded to take the usual precautions with wild game that have been shared at this blog.

This story will be published tomorrow. It is located at the LA Times website

• http://tinyurl.com/y3klxj LA Times

and at the KTLA TV website

• KTLA http://ktla.trb.com/news/la-sci-kipnuk22oct22

Currently the video is flaky (unstable).

A few things to point out. Although the Feds had know about the sampling plan for over a year (sampling started in 2005) the news was not known until after the 2006 sampling and news coverage began. See early March,

• http://ykalaska.wordpress.com/2006/03/13/re-google-news-proxy/ RE: Google news proxy

and

• Google news proxy -
  http://ykalaska.wordpress.com/2006/03/11/google-news-proxy/

The flyers came out in mid-March, just after the news announcements of the 2006 sampling.

• A Few Facts about Avian Influenza in Alaska -
  http://ykalaska.wordpress.com/2006/03/21/a-few-facts-about-avian-influenza-in-alaska/

The strong effort to advertise there is no bird flu and that birds can be hunted, continued even after bird flu, including H5N1, was confirmed in the tested birds. This information has not been as widely disseminated. There has been little follow-up on local preparedness.

Alaska villagers living in bird flu’s flight path
What has brought the Eskimos sustenance for generations now may carry the deadly virus into North America

By JIA-RUI CHONG, Times Staff Writer, October 22, 2006

• http://tinyurl.com/y3klxj LA Times

Soon, latex gloves appeared on store shelves and Wild West-style posters started popping up around town: “Wanted: Birds of the Delta.” Researchers camped out in the town’s tribal council offices, preparing for trips to nearby Kwigluk Island with vials, swabs, nets and needles.

They came bearing a warning: The wild birds that the Yup’ik have hunted for millenniums may be carrying the first traces of the deadly bird flu virus from Asia into North America….

The nervousness has waned through the summer, said the 58-year-old ex-Army sergeant, but still, “We don’t joke about what we eat here.”

…The coastal location is one reason health officials chose Kipnuk as one of 10 villages for testing. The other main reason is the vigor of its hunters.

Kipnuk villagers hunt intensely through the summer, stocking up on birds, which they usually roast into a crispy meal or boil into a soup made with onions, rice and macaroni. Peter keeps two freezers stuffed with various birds — some plucked, some not….

…The health corporation began preparing residents in the spring with a newsletter outlining some of the dangers of bird flu.

The newsletter’s advice was simple: Don’t eat, drink or smoke when cleaning birds, and cook the meat thoroughly.

This has caused some problems.

One of the delicacies of tundra life is half-cooked eider. ..

As a chill set in, he disemboweled his birds in the traditional style: hooking one finger into the cloaca and tearing out the intestines with one motion.

He wiped his hand on the damp grass.

Peter said he was worried, but not that worried, yet. “Nobody’s gotten sick,” he said….

http://tinyurl.com/y6vyqv Video– “Drawing a line in the Tundra” [sic]

• Yup’ik Eskimos hunting (photos) -
  http://ktla.trb.com/news/ la-birdflu-pg,0,4967582.photogallery?coll=ktla-news-1

I found the newstory had a mixed voice; an element of sympathy but also exoticism. Untouched by the reporter and by us is the necessary larger discussion of “tradition” vs “modernism”. [If tradition weren't evolving it wouldn't be tradition and we would be extinct as a community. If Cabela's and shotguns and freezers are indigenous hunting tools (and they are) so too are hand sanitizers and safe food handling. We know from our own history that once people get sick, in 1918, in 1950s, in 2005, it is too late for prevention. Part of tradition is getting ready; we need our institutions to catch up.]

It’s interesting, too, that The Birds are again the harbingers of human disasters (see

• Google news proxy measure — H5N1 public involvement -
  http://ykalaska.wordpress.com/2006/03/11/ google-news-proxy-measure-%e2%80%94-h5n1-public-involvement/

). We forget to our peril that, to paraphrase Pogo, we have seen the environment and it is us.

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Site Search Tags: cloaca, Kipnuk, hunter, LATimes, geese, video