All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation.

Objective: International studies describing COVID-19 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS-CoV-2 at a large Australian tertiary children's hospital according to the state health department guidelines, which varied over time. Methods: We conducted a retrospective cohort study at The Royal Children's Hospital, Melbourne, Australia. It included all paediatric patients (aged 0-18 years) who presented to the ED or the Respiratory Infection Clinic (RIC) and were tested for SARS-CoV-2. The 30-day study period commenced after the first confirmed positive case was detected at the hospital on 21 March 2020, until 19 April 2020. We recorded epidemiological and clinical data. Results: There were 433 patients in whom SARS-CoV-2 testing was performed in ED (331 [76%]) or RIC (102 [24%]). There were four (0.9%) who had positive SARS-CoV-2 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS-CoV-2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS-CoV-2 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID-19 were identified in 4/4 SARS-CoV-2 positive patients and 47/429 (11%) SARS-CoV-2 negative patients. Conclusion: Our study identified a very low rate of SARS-CoV-2 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS-CoV-2 negative had comorbidities.

Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.

The frequency of cases of accelerated silicosis associated with exposure to dust from processing artificial stones is rapidly increasing globally. Artificial stones are increasingly popular materials, commonly used to fabricate kitchen and bathroom worktops. Artificial stones can contain very high levels of crystalline silica, hence cutting and polishing them without adequate exposure controls represents a significant health risk. The aim of this research was to determine any differences in the emission profiles of dust generated from artificial and natural stones when cutting and polishing. For artificial stones containing resins, the nature of the volatile organic compounds (VOCs) emitted during processing was also investigated. A selection of stones (two natural, two artificial containing resin, and one artificial sintered) were cut and polished inside a large dust tunnel to characterize the emissions produced. The inhalable, thoracic, and respirable mass concentrations of emissions were measured gravimetrically and the amount of crystalline silica in different size fractions was determined by X-ray diffraction. Emissions were viewed using scanning electron microscopy and the particle size distribution was measured using a wide range aerosol spectrometer. VOCs emitted when cutting resin-artificial stones were also sampled. The mass of dust emitted when cutting stones was higher than that emitted when polishing. For each process, the mass of dust generated was similar whether the stone was artificial or natural. The percentage of crystalline silica in bulk stone is likely to be a reasonable, or conservative, estimate of that in stone dust generated by cutting or polishing. Larger particles were produced when cutting compared with when polishing. For each process, normalized particle size distributions were similar whether the stone was artificial or natural. VOCs were released when cutting resin-artificial stones. The higher the level of silica in the bulk material, the higher the level of silica in any dust emissions produced when processing the stone. When working with new stones containing higher levels of silica, existing control measures may need to be adapted and improved in order to achieve adequate control.