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OBJECTIVETo determine whether internal components of powered air purifying respirators (PAPR) used during the Corona virus 2019 disease (COVID-19) pandemic are contaminated with bacteria, fungi and/or any viral material.DESIGN & SETTINGIn situ microbiological study. Single NHS Trust, UK.OUTCOME MEASURESGrowth of any bacteria or fungi, or positive polymerase chain reaction results for common respiratory viruses and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)RESULTS25 PAPR hoods were swabbed; ten (40%) returned positive results. Bacterial growth was detected on six hoods (bacillus simplex, kocuria rhizophilia, bacillus weihenstephensis, microcccus luteus and staphylococcus epidermidis); five of the hoods were positive for fungal growth (non-sporulating environmental mould, NSEM); all sampled hoods tested negative for both SARS-CoV-2 and an expanded panel of respiratory viruses. There was wide variation in the storage of cleaned hoods.CONCLUSIONDespite following recommended cleaning procedures, bacteria and fungi can remain on the internal components of PAPR hoods, at levels significant enough to be swabbed and cultured. PAPR hoods have the potential to cross-infect wearers and patients and are used primarily by clinicians who fail to fit disposable FFP3 respirators; the female sex and non-Caucasian people are less likely to fit FFP3 respirators. The hoods tested cannot be adequately cleaned for use in high risk healthcare environments, PAPR hoods and tubes can act as fomites, and there are evident shortcomings in their provision.SUMMARYWHAT IS ALREADY KNOWN ON THIS TOPICPrior to this study there had been no similar investigations looking at the microbiological contamination of PAPR hoods in situ in the real work place hospital environment.SARS-CoV-2 is able to persist in an infective state on surfaces for up to 72 hours.The possibility of internal contamination of PAPR had never been addressed by manufacturers as the hoods were not designed for shared usage.WHAT THIS PAPER ADDSPAPR hoods in their current form risk transmitting infection between users, and do not protect patients from infected healthcare workersIt is possible to detect biological agents within the PAPR hoods despite cleaning as per guidelinesAn infected asymptomatic carrier is at risk of infecting those around them due to contaminated exhalation

Application for Research Ethics Committee (REC) approval and the conduct of medical research is paper intensive. This retrospective study examined all applications to a single REC in the south of England over one year. It estimated the mass of paper used, comparing the proportional paper consumption of different trial types and during different stages of the research process, quantifying the consumption in terms of carbon dioxide emissions. In 2009, 68 trials were submitted to the REC. Total paper consumption for the REC process and study conduct was 176,150 sheets of A4 paper (879 kg), equivalent to an estimated 11.5 million sheets (88 tonnes, 2,100 trees) a year for the UK; the REC process accounted for 26.4%. REC applica- tions and the conduct of approved trials generate considerable environmental impact through paper consumption contributing to the NHS's carbon footprint. Paper use might be reduced through the implementation of digital technologies and revised research methods, namely changing attitudes in both researchers and ethics committees.

“Anyone know what a doula is?” I asked in the coffee room. I was met with a roomful of blank faces. Earlier, during the morning obstetric meeting, a midwife told me that her patient had a doula. “A what?” I asked. “You know,” she said, “a birthing partner.” I didn’t know; anyway, isn’t that the job of the partner or the baby’s grandmother? The word doula derives from the ancient Greek for “woman of service.” Recently it has been used to describe experienced women who help mothers care for newborn infants; the role now extends to attending prenatal classes and the birth itself. On this occasion an epidural had been inserted as per the birth plan, and I was called to assess the patient’s analgesia, as she complained of discomfort. I found a missed segment and planned an epidural bolus with repositioning. The doula had been present since admission, as had the husband. Both the mother and father were confident and articulate, so I couldn’t help but wonder why they needed to pay for support. In my practice the mother is the principal focus, but I address the couple together, recognising their joint experience of bringing a new life into the world. I found myself disconcerted by the doula’s presence, as I was unfamiliar with …

An over the counter fetal heart monitor can be a fun purchase for expectant parents eager to hear their unborn child. But Abhijoy Chakladar and Hazel Adams warn that parents shouldn’t rely on the devices to indicate fetal health

The UK Health Protection Agency advises that health care workers caring for patients with probable or confirmed flu-like illnesses, where aerosol generating procedures are being undertaken, to use filtering face piece-3 (FFP3) respirators.

FFP3 (filtering face piece 3) respirators are recommended for health care workers caring for patients with probable or confirmed flu-like illness where aerosol generating procedures are being undertaken.1 2 We recently admitted our first patient with suspected swine flu to intensive care on a weekend night shift. …