Conference Material > Video
Dorion C
MSF Scientific Day International 2024. 25 May 2024; DOI:10.57740/lG133b8
Conference Material > Slide Presentation
Guglielmetti L, Khan U, Velasquez GE, Gouillou M, Lachenal N, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/HWpBuX
Conference Material > Video
Wilson JM
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/lFkucQsZjP
Conference Material > Abstract
Sterk E, Schramm B, Riccio E, Gabut M, Fontana L, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Dz2BnS7
INTRODUCTION
The 2014 West Africa Ebola outbreak underlined inadequacies of current personal protective equipment (PPE), such as being uncomfortable and hot, causing excessive sweating and rapid exhaustion, and limiting interactions between health workers and patients. The smartPPE development project responded to the urgent need for a more comfortable, simpler, and sustainable PPE solution for filovirus-outbreak front-line workers. A one- piece, reusable smartPPE with ventilation system was developed to address these challenges. We assessed ease-of-use, comfort, functionality, and perceived doffing-safety of the smartPPE prototype compared with currently used PPE (current-PPE) under simulated field conditions.
METHODS
In June 2023, we conducted a mixed-methods crossover usability study in a controlled high-heat/high-humidity indoor site in Brindisi, Italy. Ten test users (three female, seven with filovirus-front-line experience) assessed smartPPE and current- PPE in four guided sessions covering donning, (emergency) doffing, clinical tasks, and heavy physical WATSAN activities. User feedback was collected through structured questionnaires. Temperature, humidity, session duration, and vital signs were measured, and perceived exertion was assessed using Borg- scores (scale 6–20).
RESULTS
Median temperature and humidity were higher inside current- PPE than inside smartPPE (difference: 2.3°C [IQR 1.8–3.0] and 12.6 percentage points [8.8–19.6], respectively). Users endured heavy work sessions for significantly longer in smartPPE than in current-PPE (80.0 min [IQR 75–84] vs 49.5 min [45–56]). Median increases in body temperature (1.1°C [IQR 0.7–1.6] vs 0.7°C [0.3–0.9]; p<0.001) and respiratory rate (3.5 rpm [1–5] vs 1.5 rpm [0–3]; p=0.034), and reductions in O2 saturation (–2% [–5 to –1] vs –1.5% [–3 to 0]; p=0.027) were higher with current-PPE than with smartPPE. Peripheral vision was similarly rated, but hearing was compromised with smartPPE at ≥5 m. Median exertion- scores were lower for smartPPE (clinical tasks 8.5 [IQR 7–11] vs 15.5 [14–16] p<0.01; heavy physical activities 14 [13–17] vs 18 [17–20] p=0.035). All users preferred smartPPE for overall and thermal comfort, breathing, and doffing-safety; nine (90%) favoured it for non-verbal communication, eight (80%) for vision or longer-interval heavy WATSAN activities, six (60%) for longer- interval patient care, six (60%) for short-term clinical activities, and six (60%) for emergency doffing. Reported concerns were airflow obstruction while bending, hearing difficulties attributed to ventilation noise, and adjustments for headgear, ventilation, and suit fitting.
CONCLUSION
Test users confirmed the usability of smartPPE and favoured it, especially for doffing-safety, longer-interval clinical or physical work, and improved non-verbal interactions, whereas hearing was challenged by the ventilation. Adjustments are currently underway before design freeze. Stakeholder commitment will be crucial to ensure production at scale.
The 2014 West Africa Ebola outbreak underlined inadequacies of current personal protective equipment (PPE), such as being uncomfortable and hot, causing excessive sweating and rapid exhaustion, and limiting interactions between health workers and patients. The smartPPE development project responded to the urgent need for a more comfortable, simpler, and sustainable PPE solution for filovirus-outbreak front-line workers. A one- piece, reusable smartPPE with ventilation system was developed to address these challenges. We assessed ease-of-use, comfort, functionality, and perceived doffing-safety of the smartPPE prototype compared with currently used PPE (current-PPE) under simulated field conditions.
METHODS
In June 2023, we conducted a mixed-methods crossover usability study in a controlled high-heat/high-humidity indoor site in Brindisi, Italy. Ten test users (three female, seven with filovirus-front-line experience) assessed smartPPE and current- PPE in four guided sessions covering donning, (emergency) doffing, clinical tasks, and heavy physical WATSAN activities. User feedback was collected through structured questionnaires. Temperature, humidity, session duration, and vital signs were measured, and perceived exertion was assessed using Borg- scores (scale 6–20).
RESULTS
Median temperature and humidity were higher inside current- PPE than inside smartPPE (difference: 2.3°C [IQR 1.8–3.0] and 12.6 percentage points [8.8–19.6], respectively). Users endured heavy work sessions for significantly longer in smartPPE than in current-PPE (80.0 min [IQR 75–84] vs 49.5 min [45–56]). Median increases in body temperature (1.1°C [IQR 0.7–1.6] vs 0.7°C [0.3–0.9]; p<0.001) and respiratory rate (3.5 rpm [1–5] vs 1.5 rpm [0–3]; p=0.034), and reductions in O2 saturation (–2% [–5 to –1] vs –1.5% [–3 to 0]; p=0.027) were higher with current-PPE than with smartPPE. Peripheral vision was similarly rated, but hearing was compromised with smartPPE at ≥5 m. Median exertion- scores were lower for smartPPE (clinical tasks 8.5 [IQR 7–11] vs 15.5 [14–16] p<0.01; heavy physical activities 14 [13–17] vs 18 [17–20] p=0.035). All users preferred smartPPE for overall and thermal comfort, breathing, and doffing-safety; nine (90%) favoured it for non-verbal communication, eight (80%) for vision or longer-interval heavy WATSAN activities, six (60%) for longer- interval patient care, six (60%) for short-term clinical activities, and six (60%) for emergency doffing. Reported concerns were airflow obstruction while bending, hearing difficulties attributed to ventilation noise, and adjustments for headgear, ventilation, and suit fitting.
CONCLUSION
Test users confirmed the usability of smartPPE and favoured it, especially for doffing-safety, longer-interval clinical or physical work, and improved non-verbal interactions, whereas hearing was challenged by the ventilation. Adjustments are currently underway before design freeze. Stakeholder commitment will be crucial to ensure production at scale.
Conference Material > Slide Presentation
Wardley T, West KP, Tesfay B, Robinson N, Parry L, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/EQ5OG2MuMi
Conference Material > Slide Presentation
Rapoud D, Cramer E, Al Asmar M, Sagara F, Ndiaye B, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/2acXDPpuix
Conference Material > Poster
Elsinga J, Sunyoto T, Di Stefano L, Giorgetti PF, Kyi HA, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/63l6oZ
Conference Material > Slide Presentation
Finger F, Mimbu N, Ratnayake R, Meakin S, Bahati JB, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/tC1av3293
Conference Material > Abstract
Ahortor E, Mahazu S, Manful T, Erber A, Ablordey A
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/MAt4h7
INTRODUCTION
Buruli ulcer caused by Mycobacterium ulcerans is a devastating necrotic skin disease. PCR, recommended for confirmation of Buruli ulcer by WHO, requires an adequately equipped laboratory, often delaying diagnosis and treatment of patients in remote or humanitarian settings. We aimed to assess loop- mediated isothermal amplification (LAMP), which is a molecular assay for isothermal amplification of DNA suggested for timely diagnosis of Buruli ulcer in low-resource settings.
METHODS
This study combines quantitative and qualitative methods. First, we evaluated a simple rapid syringe DNA extraction method (SM) in comparison with a conventional extraction method (CM), followed by a LAMP assay targeting IS2404 for the detection of M ulcerans, either using a pocket warmer (pw) or a heat block (hb) for incubation of the reaction. 83 clinical specimens (swabs and fine-needle aspirates from different centres in Ghana) were tested. We assessed sensitivity, specificity, and positive and negative predictive value (PPV and NPV). Second, we explored the diagnostic workflow for Buruli ulcer at a community-based health centre in rural Ghana, a potential target setting. We used observations and interviews with researchers and healthcare workers (HCWs) and community-based surveillance volunteers. We discuss evaluation results in relation to the target setting and requirements of a target product profile for Buruli ulcer diagnosis.
RESULTS
DNA extraction using SM followed by IS2404 PCR (IS2404 PCRSM) identified M ulcerans DNA in 73 of 83 clinical specimens. The sensitivity, specificity, PPV, and NPV of IS2404 PCRSM were 90.12%, 100%, 100%, and 65.21%, respectively, compared
with the reference standard IS2404 PCR with the CM protocol. Evaluation of the LAMP assay on 64 SM DNA extracts showed a sensitivity, specificity, PPV, and NPV of 83.6%, 100%, 100%, and 50%, respectively, using either pw (pwLAMPSM) or hb (hbLAMPSM) for incubation, compared with the same reference standard. The limit of detection of both pwLAMPSM and hbLAMPSM was 30 target copies. Interviews confirmed that, despite great engagement from HCWs and volunteers, patients met challenges regarding transport and costs for initial diagnosis and follow- up and often sought alternative treatments first. Diagnostic confirmation via PCR in a reference laboratory led to a delay in the initiation of treatment. A diagnosis at the point of care, following clinical screening, was considered advantageous to prevent delays and loss to follow-up, therefore ensuring timely patient treatment.
CONCLUSION
Our findings support the potential use of pwLAMP for rapid diagnosis of Buruli Ulcer in patients with a suspected infection at the community or primary health-care level, with limited equipment and without reliable electricity supply such as found in humanitarian settings.
Buruli ulcer caused by Mycobacterium ulcerans is a devastating necrotic skin disease. PCR, recommended for confirmation of Buruli ulcer by WHO, requires an adequately equipped laboratory, often delaying diagnosis and treatment of patients in remote or humanitarian settings. We aimed to assess loop- mediated isothermal amplification (LAMP), which is a molecular assay for isothermal amplification of DNA suggested for timely diagnosis of Buruli ulcer in low-resource settings.
METHODS
This study combines quantitative and qualitative methods. First, we evaluated a simple rapid syringe DNA extraction method (SM) in comparison with a conventional extraction method (CM), followed by a LAMP assay targeting IS2404 for the detection of M ulcerans, either using a pocket warmer (pw) or a heat block (hb) for incubation of the reaction. 83 clinical specimens (swabs and fine-needle aspirates from different centres in Ghana) were tested. We assessed sensitivity, specificity, and positive and negative predictive value (PPV and NPV). Second, we explored the diagnostic workflow for Buruli ulcer at a community-based health centre in rural Ghana, a potential target setting. We used observations and interviews with researchers and healthcare workers (HCWs) and community-based surveillance volunteers. We discuss evaluation results in relation to the target setting and requirements of a target product profile for Buruli ulcer diagnosis.
RESULTS
DNA extraction using SM followed by IS2404 PCR (IS2404 PCRSM) identified M ulcerans DNA in 73 of 83 clinical specimens. The sensitivity, specificity, PPV, and NPV of IS2404 PCRSM were 90.12%, 100%, 100%, and 65.21%, respectively, compared
with the reference standard IS2404 PCR with the CM protocol. Evaluation of the LAMP assay on 64 SM DNA extracts showed a sensitivity, specificity, PPV, and NPV of 83.6%, 100%, 100%, and 50%, respectively, using either pw (pwLAMPSM) or hb (hbLAMPSM) for incubation, compared with the same reference standard. The limit of detection of both pwLAMPSM and hbLAMPSM was 30 target copies. Interviews confirmed that, despite great engagement from HCWs and volunteers, patients met challenges regarding transport and costs for initial diagnosis and follow- up and often sought alternative treatments first. Diagnostic confirmation via PCR in a reference laboratory led to a delay in the initiation of treatment. A diagnosis at the point of care, following clinical screening, was considered advantageous to prevent delays and loss to follow-up, therefore ensuring timely patient treatment.
CONCLUSION
Our findings support the potential use of pwLAMP for rapid diagnosis of Buruli Ulcer in patients with a suspected infection at the community or primary health-care level, with limited equipment and without reliable electricity supply such as found in humanitarian settings.
Conference Material > Video
Erber A
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Wwa8RTd