The personal protective equipment(PPE)based on individual combat:A systematic review and trend analysis

With the development of ordnance technology,the survival and safety of individual combatants in hightech warfare are under serious threat,and the Personal Protective Equipment(PPE),as an important guarantee to reduce casualties and maintain military combat effectiveness,is widely developed.This paper systematically reviewed various PPE based on individual combat through literature research and comprehensive discussion,and introduced in detail the latest application progress of PPE in terms of material and technology from three aspects:individual integrated protection system,traditional protection equipment,and intelligent protection equipment,respectively,and discussed in depth the functional improvement and optimization status brought by advanced technology for PPE,focusing on the achievements of individual equipment technology application.Finally,the problems and technical bottlenecks in the development of PPE were analyzed and summarized,and the development trend of PPE were pointed out.The results of the review will provide a forward-looking reference for the current development of individual PPE,and are important guidance for the design and technological innovation of advanced equipment based on the future technological battlefield.

Force application of laparoscopic surgeons under the impact of heavy personal protective equipment during COVID-19 pandemic

Objective:Surgeons are required to wear heavy personal protective equipment while delivering care to patients during the COVID-19 pandemic.We examined the impact of wearing double gloves on surgeons’performance in laparoscopic surgery.Methods:Eleven surgeons-in-training at the Surgical Simulation Research Lab of the University of Alberta were recruited to perform laparoscopic cutting tasks in simulation while wearing none,one pair,and two pairs of surgical gloves.Forces applied to laparoscopic instruments were measured.Results:Wearing gloves prolonged task times(one pair of gloves:301.6±61.7 s;two pairs of gloves:295.8±65.3 s)compared with no gloves(241.7±46.9 s;p=0.043).Wearing double gloves increased cutting errors(20.4±5.1 mm^(2))compared with wearing one pair of gloves(16.9±5.5 mm^(2))and no gloves(14.4±4.6 mm^(2);p=0.030).Wearing gloves reduced the peak force(one pair of gloves:2.4±0.7 N;two pairs of gloves:2.7±0.6 N;no gloves:3.4±1.4 N;p=0.049),and the total force(one pair of gloves:10.1±2.8 N;two pairs of gloves:10.3±2.6 N;no glove:12.6±1.9 N;p=0.048)delivered onto lapa-roscopic scissors compared with wearing no glove.Conclusion:The combined effects of wearing heavy gloves and using tools reduced the touching sensation,which limited the surgeons’confidence in performing surgical tasks.Increasing practice in simulation is suggested to allow surgeons to overcome difficulties brought by personal protective equipment.

Unmasking the mask:the role of personal protective equipment for ophthalmologists caring for asymptomatic patients during the COVID-19 pandemic

The use of personal protective equipment(PPE)for ophthalmologists caring for asymptomatic patients remains controversial.This commentary reviews the latest emerging evidence.This is paramountly important in shaping health policies in countries which is not currently recommended.

Skin damage due to personal protective equipment among nursing staff in a dedicated coronavirus disease-2019 hospital of tribal India

Background:Nursing staff are at much greater risk of infection(Ebola virus diseases and severe acute respiratory syndrome)due to their exposure to highly infectious bodily fluids and droplet nuclei and the need for personal protective equipment(PPE)to reduce the transmission risk.Aim:The present study was conducted to estimate the prevalence of skin injuries and their types due to PPE usage among nursing staff in tribal India.Materials and Methods:This descriptive cross-sectional study was conducted in the dedicated coronavirus disease-2019(COVID-19)hospital for a period of 4 months among 144 nursing staff wearing Grade 2 and 3 PPE kits.Study subjects were approached through social networking websites and survey questionnaires(Google forms)according to relevant guides,and research literature was used to collect the details regarding baseline,duty,and skin injury characterization.Chi-square test was used to find the association between skin injury and baseline or duty characteristics,and the association was significant at a P<0.05.Results:It was observed that 54.7%of nursing staff were working for 6 or more hours and 16.5%of subjects were wearing the PPE kit for 5 or more hours per day.Skin injury was reported by 86.3%of the subjects after using PPE.Skin injuries among nurses were statistically significant with their current place of stay and daily duty hours(P<0.05).Conclusion:In this study,it was found that 86.3%of subjects had suffered from skin injuries by using PPE while caring for COVID-19 patients during duty hours,so an effective preventive measure should be adopted.

Practices and Barriers for Personal Protective Equipment among Health Care Workers during COVID-19 Pandemic Management at Tertiary Care Government Hospital of South Gujarat, India

Introduction: The recent COVID-19 pandemic has prompted concern about the compatibility of IPC guidelines with health care workers, their working practices and behaviours. These guidelines can be difficult and time-consuming to adhere to in practice. By identifying barriers and facilitators to IPC guideline adherence, especially using personal protective equipment (PPE), we can identify focussed strategies that will support health care workers to undertake the IPC measures needed at such a critical time in health care internationally. Material & Methods: This was a cross-sectional study designed during the COVID-19 pandemic management in the South Gujarat region, to analyse the knowledge, attitude and practices of health care workers about their usage of personal protective equipment. A semi-structured questionnaire-based study was prepared, deriving pointers from our previous experience of seasonal flu outbreaks. 225 participants enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Result: Analysis of the barriers-related questions show good preparedness by the medical institution. Overall we found good knowledge, attitude and practice related to PPE during COVID-19 pandemic management. There are few gaps found in the knowledge of donning of PPE (p-0.0075), N-95 mask related knowledge (p-0.01) and the attitude that PPE use causes discomfort while nursing patients (0.0001).

Self-Reported Use of Personal Protective Equipment during the SARS-CoV-2 Pandemic in Emergency Medical Service Employees in Germany—A Survey

Background: Multicentric prospective cohort investigation survey conducted between 1st of March and 1st of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. Study Objectives: Primary: The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. Secondary: Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. Methods: Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. Results: A total of 34 responses were received in the managerial group;a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). Conclusions: Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.

An Automated Detection Approach of Protective Equipment Donning for Medical Staff under COVID-19 Using Deep Learning

Personal protective equipment(PPE)donning detection for medical staff is a key link of medical operation safety guarantee and is of great significance to combat COVID-19.However,the lack of dedicated datasets makes the scarce research on intelligence monitoring of workers’PPE use in the field of healthcare.In this paper,we construct a dress codes dataset for medical staff under the epidemic.And based on this,we propose a PPE donning automatic detection approach using deep learning.With the participation of health care personnel,we organize 6 volunteers dressed in different combinations of PPE to simulate more dress situations in the preset structured environment,and an effective and robust dataset is constructed with a total of 5233 preprocessed images.Starting from the task’s dual requirements for speed and accuracy,we use the YOLOv4 convolutional neural network as our learning model to judge whether the donning of different PPE classes corresponds to the body parts of the medical staff meets the dress codes to ensure their self-protection safety.Experimental results show that compared with three typical deeplearning-based detection models,our method achieves a relatively optimal balance while ensuring high detection accuracy(84.14%),with faster processing time(42.02 ms)after the average analysis of 17 classes of PPE donning situation.Overall,this research focuses on the automatic detection of worker safety protection for the first time in healthcare,which will help to improve its technical level of risk management and the ability to respond to potentially hazardous events.

Lot Sizing in Production Scheduling at a Personal Protection Equipment Company

This work presents an optimization model to support decisions during production planning and control in the personal protective equipment (PPE) industry (in particular, gloves). A case study was carried out at a Brazilian company with the aim of increasing productivity and improving customer service with respect to meeting deadlines. In this case study, the mixed integer linear programming model of Luche (2009) was revisited. A new model for single-stage lot sizing was applied to the production scheduling of gloves. Optimizing this scheduling was not a simple task because of the scale of the equipment setup time, the diversity of the products and the deadlines for the orders. The model was implemented in GAMS IDE and solved by CPLEX 12. The model and the associated heuristic produce better solutions than those currently used by the company.

Real-Time Safety Helmet Detection Using Yolov5 at Construction Sites

The construction industry has always remained the economic and social backbone of any country in the world where occupational health and safety(OHS)is of prime importance.Like in other developing countries,this industry pays very little,rather negligible attention to OHS practices in Pakistan,resulting in the occurrence of a wide variety of accidents,mishaps,and near-misses every year.One of the major causes of such mishaps is the non-wearing of safety helmets(hard hats)at construction sites where falling objects from a height are unavoid-able.In most cases,this leads to serious brain injuries in people present at the site in general and the workers in particular.It is one of the leading causes of human fatalities at construction sites.In the United States,the Occupational Safety and Health Administration(OSHA)requires construction companies through safety laws to ensure the use of well-defined personal protective equipment(PPE).It has long been a problem to ensure the use of PPE because round-the-clock human monitoring is not possible.However,such monitoring through technological aids or automated tools is very much possible.The present study describes a systema-tic strategy based on deep learning(DL)models built on the You-Only-Look-Once(YOLOV5)architecture that could be used for monitoring workers’hard hats in real-time.It can indicate whether a worker is wearing a hat or not.The proposed system usesfive different models of the YOLOV5,namely YOLOV5n,YOLOv5s,YOLOv5 m,YOLOv5l,and YOLOv5x for object detection with the support of PyTorch,involving 7063 images.The results of the study show that among the DL models,the YOLOV5x has a high performance of 95.8%in terms of the mAP,while the YOLOV5n has the fastest detection speed of 70.4 frames per second(FPS).The proposed model can be successfully used in practice to recognize the hard hat worn by a worker.

Experiences of Social Isolation in Older Hospitalized Patients with COVID-19 and Their Close Relatives: A Qualitative Study

Background: Proximity between older patients and their close relatives is essential during hospitalisation. During the first wave of the pandemic, the Danish Patient Safety Authority restricted no hospital visitors. Aim: To explore how older patients with COVID-19 and their close relatives experienced physical separation during hospitalization. Method: A qualitative study using semi-structured interviews and thematic analysis was employed. Findings: Six interviews were conducted: three patients with a mean age of 81 years and three close relatives—two daughters and one spouse. The patients felt boredom, loneliness, and a sense of imprisonment, yet they felt safe and satisfied. Isolation was known beforehand from the media. Close relatives emphasised that information, involvement, and collaboration with hospital staff were crucial. Conclusion: Although older patients with COVID-19 and their close relatives widely accept their situation during hospitalization, they experience negative consequences from social isolation.

Optimization of the intravenous infusion workflow in the isolation ward for patients with coronavirus disease 2019

Objective:This study aimed to evaluate the effect of optimization of the intravenous infusion workflow in isolation wards for patients with coronavirus disease 2019.Methods:The infusion management group optimized the intravenous infusion workflow based on Hamer's Process Reengineering Theory and applied it to the treatment of patients with coronavirus disease 2019.The work efficiency,patients'satisfaction and economic indicators before and after optimization were compared.Results:After the infusion workflow was optimized,average times for preparation drugs and intravenous admixture,and patients'waiting time decreased from 4.84 min,4.03 min,and 34.33 min to 3.50 min,2.60 min,and 30.87 min,respectively,patients'satisfaction increased from 66.7%to 93.3%,and the cost of personal protective equipment(PPE)decreased from 46.67 sets and 186.6 CNY per day to 36.17 sets and 144.6 CNY,with statistical significance.Conclusion:The optimization of the intravenous infusion workflow can effectively decrease the cost of PPE while improving the efficiency of infusion and patients'satisfaction.

Standard precaution measurements during ophthalmology practice in the pandemic stage of COVID-19

AIM:To take specific precautions and keep a safe practice during providing ophthalmology health services without compromising the patient’s safety as well as the team workers and the community in the pandemic stage of corona virus disease 2019(COVID-19).METHODS:Applying patient circulation scheme implemented in our ophthalmology centers with the guidance of ministry of health infection control guidelines star ted from the moment that we receive a call or Whats App message or Facebook inquiry from patients until 21 d after patients first visit if any.Four directions were taken.First,community awareness of the disease and the ophthalmology related advices in how eye can transfers the infection and how to protect our eyes not to be infected through videos interviews of our consultants and distribution in social media like Instagram,Facebook,Whats App pages radio and TV interviews as well as leaflet health awareness for distribution for public.Second,scheduling of patients’appointments to prevent overcrowdings and cross infection.Third,protective measurements tools in the center to detect and prevent any exposure of the patients to patients and to protect medical staff,COVID-19 scoring system was set up to identify patients with fever,respiratory symptoms,acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 21 d.Proper use of personal protective equipment was implemented.Stopping all the elective surgeries keeping only the emergency types advised by fourth:how to deal with our patients if they need an urgent ophthalmological intervention and how to deal with suspected cases of corona if any cases detected.RESULTS:Our measures helped our colleagues to try to keep providing ophthalmology health services without increasing the incidence of infection for COVID-19 until this pandemic is over.CONCLUSION:In our practice,ophthalmologists should work with new aura of social media to facilitate the nondirect communication with the patients through maximizing the use of communication technology to keep contact with their patients and deal safely with COVID-19 cases.

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019(COVID-19)for surgeons is not quantified which may be affected by their risk of exposure and individual factors.The objective of this review is to quantify the risk of COVID-19 among surgeons,and explore whether facemask can minimise the risk of COVID-19 among surgeons.A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers(HCWs)especially those work in surgical specialities including surgical nurses and intensivists.Additionally,systematic reviews that assessed the effectiveness of facemask against viral respiratory infections,including COVID-19,among HCWs were identified.Data from identified articles were abstracted,synthesised and summarised.Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask(and other personal protective equipment)were summarised.Although the risk of COVID-19 could not be quantified precisely among surgeons,about 14%of HCWs including surgeons had COVID-19,there could be variations depending on settings.Facemask was found to be somewhat protective against COVID-19,but the HCWs’compliance was highly variable ranging from zero to 100%.Echoing surgical societies’guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

Real-world clinical data of endoscopy-based cancer detection during the emergency declaration for COVID-19 in Japan

The impact of the coronavirus disease 2019(COVID-19)pandemic is widespread throughout the world,causing serious damage to healthcare systems.Therefore,we examined the significance of endoscopy based on the recommendation of Asian-Pacific Society for Digestive Endoscopy and Japan Gastroenterological Endoscopy Society during the COVID-19 pandemic by evaluating the details of gastrointestinal endoscopy performed during the declaration of emergency in Japan.We have continued performing gastrointestinal endoscopy at an outpatient clinic that specialized in endoscopic medical care in Tokyo,Japan.During the emergency declaration period,544 patients underwent gastrointestinal endoscopy.As a control,we investigated 1327 patients who underwent gastrointestinal endoscopy during the same period in 2019.Although the total number of endoscopies during the emergency declaration was halved,the advanced cancer detection rate during the emergency declaration was significantly higher than that in 2019(P=0.04).Additionally,no COVID-19 infection was observed in healthcare workers,staff,or patients during this period.It is possible that an outpatient endoscopy units can contribute to the detection of advanced cancer,while the hospital in charge for patients with COVID-19 infection could not perform endoscopy during the declaration of emergency.

Retrospective Diagnosis of COVID-19 in an Asymptomatic Patient Undergoing Emergency Surgery

Background: With reports of higher mortality and complications occurring in patients with perioperative 2019 novel coronarvirus disease (COVID-19), most elective surgeries have been postponed. However, evidence regarding emergency surgeries in patients with COVID-19 remains scarce. We report the case of a patient with asymptomatic perioperative COVID-19, presenting with an acute abdomen requiring surgery. Case: A 25-year-old male, with a prior nasopharyngeal swab that was negative for SARS-CoV-2, presented with classical signs and symptoms of acute appendicitis. Clinical examination and investigations were not suggestive of COVID-19 infection. He underwent laparoscopic appendicectomy with infection control precautions. Post-operatively, he was found to be positive for SARS-CoV-2 but remained asymptomatic and had an uneventful recovery. Conclusion: In asymptomatic individuals with higher risks, negative test results should be viewed cautiously. The benefits of urgent surgical interventions must be weighed against the risks of complications due to perioperative COVID-19 in these patients.

Pediatric surgery during the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has had a major impact on pediatric surgery.The infection is often asymptomatic and atypical in children,while overlapping presentations with other infectious diseases generate additional diagnostic challenges.The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting.Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts.Decisionmaking can be assisted by classifying cases as elective,urgent,or an emergency according to the risks of delaying their surgical management.A workflow diagram should ideally guide the management of all cases from admission to discharge.When surgery is necessary,all staff should use appropriate personal protective equipment,and high-risk practices,such as aerosol-generating tools or procedures,should be avoided if possible.Furthermore,carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units.For example,surgical teams can be divided into small weekly rotating groups,and healthcare workers should be continuously monitored for COVID-19 symptoms.Additionally,team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use.Isolated operating rooms,pediatric intensive care units,and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases.Finally,transportation of patients should be minimal and follow designated short routes.All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Health care worker occupational experiences during the COVID-19 outbreak:A cross-sectional study

BACKGROUND Health care workers treating coronavirus disease 2019(COVID-19)patients experience burnout and stress due to overwork and poor working conditions.AIM To investigate the work experiences of frontline health care workers in Wuhan city and Qinghai province,China,during the COVID-19 outbreak.METHODS In this cross-sectional descriptive study,a self-reported questionnaire was designed to evaluate work experiences of medical staff throughout the course of the COVID-19 pandemic.A total of 178 health care workers responded to the questionnaire between February 19 and 29,2020.Higher questionnaire dimensional score confirmed dimensional advantage.RESULTS Of all dimensions evaluated by this questionnaire,the occupational value dimension had the highest mean score of 2.61(0.59),followed by the support/security dimension score of 2.30(0.74).Occupational protection scored lowest at 1.44(0.75),followed by work environment at 1.97(0.81).The social relationships dimension had an intermediate score of 2.06(0.80).Significant differences in working conditions were observed across hospital departments,with the fever ward scoring lowest.Total scores also differed significantly across workplaces;the fever outpatient department scored lowest(P<0.01).This phenomenon was likely due to the fact that work in the fever outpatient department,where many patients present to hospital,necessitates constant contact with a large number of individuals with insufficient provision of resources(such as protective equipment and social support).Medical workers in the fever outpatient department were burdened with a fear of COVID-19 infection and a lower sense of professional value as compared to workers in other hospital departments.Medical staff in Wuhan worked longer hours(P<0.01)as compared to elsewhere.The mean support/security dimension score was higher for tertiary hospital as compared to secondary hospital medical staff as well as for Wuhan area as compared to Qinghai region staff(P<0.01).Staff in Wuhan had a lower mean work environment score as compared to staff in Qinghai(P<0.05).CONCLUSION Medical staff treating COVID-19 patients in China report poor occupational experiences strongly affected by work environment,occupational protection and social relationships.Health care managers must address the occupational needs of medical staff by ensuring a supportive and safe work environment.

Endoscopy during COVID-19 pandemic: An overview of infection control measures and practical application

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has resulted in coronavirus disease 2019(COVID-19)which has affected more than 4.5 million people in 213 countries,and has been declared a pandemic by World Health Organization on March 11,2020.The transmission of SARS-CoV-2 has been reported to occur primarily through direct contact or droplets.There have also been reports that SARS-CoV-2 can be detected in biopsy and stool specimens,and it has been postulated that there is potential for fecal–oral transmission as well.Gastrointestinal symptoms have been reported in 17.6%of COVID-19 patients and transmission can potentially occur through gastrointestinal secretions in this group of patients.Furthermore,transmission can also occur in asymptomatic carriers or patients with viral shedding during the incubation period.Endoscopic procedures hence may pose significant risks of transmission(even for those not directly involving confirmed COVID-19 cases)as endoscopists and endoscopy staff are in close contact with patients during these aerosol generating procedures.This could result in inadvertent transmission of infection at time of endoscopy.

Management of Biohazards and Pandemics: COVID-19 and Its Implications in the Construction Sector

This paper investigates the impact of biohazards and pandemics on construction workers’ health and well-being. A proper selection of control methods for biohazards and pandemics like COVID-19 pandemic will result in improved public health conditions. Occupational risks in the construction industry are also examined, with a focus on biohazards and pandemics, their containment, and the implications for health and safety. A safer work environment in the construction industry is encouraged. In this study, some statistical methods were used to analyse the data obtained from sampled questionnaire. According to the findings, fewer people in poor developing countries get routine check-ups compared to developed countries. The construction industries studied have little or no insurance plans for staff. It also demonstrates that personal protective equipment (PPE) such as nasal masks, helmets, hand gloves, and work aprons can assist in the control of biohazards in the construction sector, such as asthma, cancer, and asbestosis. There should be safety awareness programmes, conferences, and seminars, as well as first-aid kits and HSE and qualified health workers on all building sites. In addition, the government should examine the site for the usage of PPEs and verify that records of family/personal medical history are maintained.