This report is showing the process and result from a project collaboration between Norrlands University hospital and  design student Simon Fredriksson.  Respiratory treatment is carried out on patients that for some reason fail to breathe sufficiently to assimilate enough oxygen to survive. The reason for why a person needs respiratory treatment can be many and the length of the treatment varies a lot. It can stretch from a couple of hours during surgery to years in treatment for example Chronic obstructive pulmonary disease (COPD) or Immature lungs.  The project focus have been to look at how to increase the freedom of movement for kids receiving respiratory treatment. Respiratory treatment are complex and involves advanced equipment. It´s demanding both physically and mentally both for patient and involved family and can in some cases carry on for several years.    A young child with impaired breathing should still have the freedom of movement and not have to be restricted to the length of a respirator hose and depend on others to be able to move around. Learning how to crawl walk and freely move around should be every childs right. The quote are from  the National heart, lung and blood institute in America. My aim is to create a concept that will offer that movement and prove them wrong. This project is carried out in collaboration with the Neonatal intensive care unit (NICU) at Norrlands University hospital in Umeå.

Introduction: Preventing healthcare professionals from acquiring occupational infectious diseases is very important in maintaining healthcare delivery systems. For protection in the work place, healthcare professionals use PPE which helps prevent exposure to pathogens during patient care. N95 respirators protect healthcare workers against airborne pathogens that are known to be associated with different respiratory diseases. Since previous studies have shown that viruses can survive on PPE surfaces, it is important to examine the survival of viruses on respirators to determine if reuse of the same N95 respirator is possible when PPE shortages occur. Goal: The goal of this research is to determine the inactivation of bacteriophage Φ6 on the surface of N95 respirators at ambient temperature and two different relative humidity levels, 40 and 60%. Result: The linear regression showed that rate of inactivation was much lower in 40% than 60% RH (40%: Slope= -0.046± 0.007040; 60%: Slope= -0.20± 0.006136). Over 24 hours, there was a ~1 Log10 reduction in virus at 20°C and 40% RH, while there was a ~4 Log10 reduction at 20°C and 60% RH. Within the timeframe of a single patient encounter, there was a <0.02 Log10 reduction in virus at 40% RH and a <0.1 Log10 reduction at 60% RH. Conclusion: Bacteriophage Φ6 survives on N95 respirators for up to 24 hours at ambient temperature and 40 and 60% relative humidity levels. Inactivation rate was lower in 40% than 60% RH. The results showed that enveloped viruses survive on the surface of N95 respirators for longer than a single patient encounter. Therefore, this should be taken into consideration when doing a risk assessment of reusing N95 respirators when shortages occur.

Bakgrund: I takt med respiratorernas utveckling har möjligheten för en lättare sedering möjliggjorts. En lättare sedering minskar risken för att utveckla komplikationer i samband med respiratorvården samt antalet dagar i respirator minskar. Patienter som är lättare sederade är mer medvetna om omgivningen och deras ökade medvetenhet ställer stora krav på vårdpersonalen. Syfte: Syftet var att sammanställa lättsederade intensivvårdspatienters upplevelser av att vårdas i respirator. Metod: En strukturerad litteraturöversikt med kvalitativ design och en induktiv ansats har använts. En tematisk syntes användes för att analysera det insamlade materialet. Resultat: Patienter som var medvetna i samband med respiratorbehandling beskrev att förlust av tal hade en stor påverkan på deras identitet och användning av alternativa kommunikationsverktyg var energikrävande. De beskrev att de blev ofrivilligt delaktiga i medpatienters vård och vårdpersonalens privata samtal. Respiratorbehandlingen orsakade smärta och obehag, där patienter beskrev törst som en av de mest dominerade obehagliga upplevelserna. Att inte kunna tillgodose sina grundläggande behov gjorde att patienter kände sig maktlösa och hjälplösa. Slutsats: Patienter som vårdas lättsederade i respirator hade en önskan att bli sedda som en unik individ och att de skulle göras delaktiga i sin vård. Information var den viktigaste faktorn för att kunna vara delaktig. Patienter som var lättsederad måste kunna göra sig förstådda, erhålla adekvat smärtlindring och bibehålla kontrollen över sin vård för att minska vårdlidandet och skydda sin integritet och värdighet.

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Introduktion: I dag ska patienter som vårdas på intensivvårdsavdelning vara så lätt sederade som möjligt. Detta kan vid samtidig respiratorvård inge känslor av panik, rädsla och otrygghet. Det är därför av stor vikt att intensivvårdssjuksköterskor vet hur de ska skapa trygghet hos patienterna, då trygghetskänslan även reducerar känslorna av panik och rädsla. Syfte: Syftet med examensarbetet var att belysa hur intensivvårdssjuksköterskor skapar trygghet för lätt sederade patienter vårdade i respirator. Metod: En kvalitativ metod användes och data samlades in genom intervjuer med 14 intensivvårdssjuksköterskor på 3 olika sjukhus. Data bearbetades utifrån Elo och Kyngäs kvalitativa innehållsanalys. Huvudresultat: I resultatet framkom fyra huvudkategorier; Genom att finnas där, Genom upprepad och anpassad information, Genom en bra miljö och yttre resurser samt Genom individanpassad vård. Diskussion: Det framkom att intensivvårdssjuksköterskorna skapade trygghet genom att involvera patienterna och de anhöriga i vården genom en god kommunikation och information. Miljön spelade även en viktig roll i trygghetsskapandet genom att minska störande ljud och inte själva vara stressade. Att skapa trygghet för lätt sederade patienter som vårdas i respirator är viktigt, då trygga patienter kan släppas upp snabbare från sederingen och ändå uppleva välbefinnande. / Introduction: The aim of caring for today’s intensive care patient is to have the patient sedated so light as possible. This can induce a sense of panic, fear and insecurity for the patient, when cared for in a mechanical ventilation. It is therefore very important that the intensive care nurse has the ability to create a sense of security for the patient, thus reducing feelings of fear and panic. Aim: The aim of this study was to illustrate how the intensive care nurses creates a sense of security when caring for light sedated patients in mechanical ventilation. Method: A qualitative method was selected and data collected through interviews with 14 intensive care nurses at 3 different hospitals. The data was processed by using Elo and Kyngäs qualitative content analysis. Main Results: The result of the study presents with four main categories; Being there, Through repeating and adapting information, Through a good climate and outer resources as well as Through individually modified care. Conclusions: It showed that the intensive care nurses created a sense of security through involve the patients and their near ones in the care of the patient through good communication and information. The environment also played a critical role through minimizing distracting noise and not to appear stressed themselves. To create sense of security for light sedated patients in mechanical ventilation is important, as when the patients experience a sense of security they could be more quickly weaned of the sedation and yet still experience a sense of wellbeing.

The emergence of nanotechnology has increased the concern of exposure to nanoparticles through inhalation. Studies have examined the performance of filtering facepiece respirators against engineered nanoparticles. This has been done by the generation and dispersal of certain particles in a given size distribution, which have then been run through experimental set-ups involving Condensation Particle Counters, Scanning Mobility Particle Sizers, and high efficiency performance filters for a set flow. Published studies have shown that the respirators used do provide expected levels of filtration protection against nanometer-sized particles. However, studies have not examined or applied different types of nanoparticle samples - different particle types have differing morphologies and physical characteristics that could affect filter performance. This study has exposed NIOSH-approved N95 facepiece respirators to six different types of engineered nanoparticles: aluminum oxide, iron oxide, single-walled carbon nanotubes, synthesized diamond, silicon dioxide, and titanium dioxide. In addition, N95 respirators have not been commonly exposed to differing concentrations of an aerosol in order to observe a shift in the primary penetrating particle size and a shift in the overall size distribution. This study challenged N95 respirators to four different concentrations of sodium chloride: 0.1, 1, 10, and 50 mg/ml. Another concern is whether or not a prolonged exposure of a single respirator affects the overall performance and protection from an aerosol, especially engineered nanoparticles, since very few studies have been done regarding this matter. N95 respirators were exposed to several types of engineered nanoparticles in a respirator testing apparatus at a set flow rate, examined for penetration with an SMPS, CPC, and DMA given these conditions: differing concentrations of sodium chloride, different engineered particles, and an extended duration of exposure to both sodium chloride and 15-nm titanium dioxide. This study showed that the primary penetrating particle size through an N95 facepiece respirator does increase and shift with increasing concentrations of an aerosol; however, the overall size distribution did not seem to shift much. Penetration decreased as sodium chloride concentration increased. Different nanoparticles had differing primary penetrating particle sizes through the respirator; however, penetration of these particles was similar to one another with the exception of iron oxide which had quite a high penetration percentage. A decrease in N95 respirator performance was observed when exposed to a 1 mg/ml solution of sodium chloride, as penetration increased with prolonged exposure. However, this did not seem to be the case when the respirator was exposed to a 6.67 mg/ml suspension of 15-nm titanium dioxide, as the penetration over the extended period of time was similar to one another.

In spite of the substantial repository of literature about respirators, little is known about the practicalities of their use. The focus of this research was about the practical aspects of using respirators in New South Wales workplaces. Two self-administered postal surveys were used to assess the level of implementation of respirator programs in 1996 and 2001. After five years, six elements improved. The most improvement was seen in the area of documentation including written procedures, keeping training records, recording respirator tasks, and maintenance records. The second survey investigated respirator maintenance and found little automated cleaning. Thorough washing was scarce with more than 50% of organisations relying on moist towelettes. For the third portion of the research methodology 485 used, half facepiece reusable respirators from 36 different sites were examined to determine the most common respirator defects. Maintenance and cleaning procedures were primitive and probably inadequate. Disinfection or sanitisation was common practice indicating concern about infectious diseases. The 2001 survey found that physical inspection of respirators in the workplace usually checked for the common types of defects found in the examination of used respirators. Weight, breathing resistance, heat and tightness were reported as causes of discomfort. The key outcomes from the research were that respirator programs were poorly implemented in a group of organisations that were expected to have more expertise than most and that the most common defects could be corrected by good respirator cleaning programs. / Doctor of Philosphy (PhD)