Maintenance of sterility in SMS packaging in dental environments: concern with biosafety

Healthcare services must be guided by biosafety practices and microbial control. This control is highly influenced by humidity, which directly impacts the maintenance of sterility of the materials used in the appointments. High concentration of moisture, in the form of aerosol, splashes and spills, is caused during dental care. During the COVID-19 times the contamination by aerosol and droplets worries greatly. Considering that it could cause harm to the sterility of an autoclaved material, especially in dental environments, the objective was to evaluate the behavior of SMS sterilization packages (Spunbonded / Meltblown / Spunbonded) against microbial penetration in an aqueous vehicle. SMS of three brands were challenged, equally divided into two groups: virgin and processed (subjected to a single autoclaving cycle). Each specimen was aseptically deposited on Macconkey agar. Subsequently, 5 µL of Escherichia coliATCC 25922 saline solution [108CFU mL-1] was deposited in center of the SMS specimen and the dish incubated at36°C/ 48h. Reading was performed by the presence or absence of bacterial growth typical of the species under the SMS, observed on the back of Petri dish. The lowest penetration rate observed was 60% for one of the brands in the virgin condition, and 75% for two brands in the processed condition. Statistical analysis showed an association between bacterial penetration and the evaluated group, this association being valid only in the virgin condition. The different SMS behave similarly in terms of resistance to bacterial penetration after being processed. The data show that moisture can assist in bacterial transport through sterilized SMS. Therefore, SMS packages are not able to prevent bacterial penetration, and possibly other microorganisms, when in aqueous vehicles, offering a potential risk of breaking the aseptic chain. Thus, care must be taken in routines for handling and storage sterile packaging.

Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School

ABSTRACT Objective To evaluate knowledge and attitudes towards biosafety recommendations during the COVID-19 pandemic at a Brazilian dental school. Material and Methods A cross-sectional study was performed in 2020 with the clinical staff of a Brazilian dental school. The whole clinical staff was sent pre-tested self-administered online questionnaires about knowledge and attitudes towards the recommendations for biosafety in dental settings in the context of the COVID-19 pandemic. Descriptive statistical analyses were carried out for proportion calculation. Results Disposable head covering caps, isolation gowns, and gloves were the most frequently reported personal protective equipment (PPE). The rates ranged from 52.9% to 88.5% for N95 respirators, from 68.6% to 92.6% for face shields, from 47.4% to 67.5% for conventional eye protection shields, and 45.1% to 77.4% for eye protection with solid side shields. Chlorhexidine gluconate was the most frequent mouthwash indicated before clinical dental care. The percentage of agreement to provide clinical care to patients with suspected COVID-19 varied from 23.5% to 50.0%. The percentage of respondents who agreed that bioaerosol-generating procedures should be avoided was higher than 74.5%. Less than 50% knew the correct sequence for doffing of PPE. Conclusion This study revealed important gaps in knowledge and attitudes towards prevention and control measures against infection in dental environments in the context of COVID-19, indicating the need for improvements.

Masks for at-risk population: nursing promoting biosafety in pandemic times.

OBJECTIVE: To describe a proposal for making and distributing masks for population in risk, with guidance on the stages of making them and the care in handling them based on the development of educational video and infographic. METHOD: Experience report on the stages of the process of training people to make fabric masks for the population at risk, between March and June 2020, in a city in the interior of São Paulo. RESULTS: 1,650 masks were made and distributed to vulnerable population groups from different contexts and tutorial video and infographic were elaborated and released to enable people to make their own masks with resources available at home. FINAL CONSIDERATIONS: It was possible to manufacture and distribute masks for the population at risk and develop educational actions to contain the disease, given the advance of confirmed cases and deaths by Covid-19, corroborating the role of nursing in health education.

A novel dental biosafety device to control the spread of potentially contaminated dispersion particles from dental ultrasonic tips.

Strategies to return to dental practice in pandemic times is a new challenge due to the generation and spread of potentially contaminated dispersion particles (PCDP) that may contain the SARS-CoV-2, the etiological factor of the COVID-19 disease. Due to the significant dispersion of PCDP in the dental environment, the use of equipment such as ultrasonic tips have been inadvisable during the pandemic. Several clinical procedures, however, benefit from the use of such equipment. Thus, using a microbial dispersion model of PCDP, the aim of this study was to compare the dispersion caused by the dental drill (DD) an ultrasonic tip (UT) alone and the UT coupled with a Spray control (SC) device. The DD, UT (with or without the SC) were activated for one minute having had the water from the reservoir replaced with a suspension of Lactobacillus casei Shirota (1.5 x 108 CFU/mL). Petri dishes containing MRS agar were positioned at 50cm, 100cm and 150cm from the headrest of the dental chair at different angles (0 degree and 90 degrees). At 50 cm, the mean CFU (standard deviation) of L. casei Shirota was 13554.60 (4071.03) for the DD, 286.67 (73.99) for the US (97.89% reduction), and 4.5 (0.58) CFU for the UT-SC (p < 0.0001), establishing a further 98.43% reduction between UT and UT with SC. The UT with SC model proved effective in reducing dispersion from the UT, endorsing its use as an additional strategy to reduce PCDP in the dental environment in times of pandemic.

Health technology assessment: Choice between a cytotoxic safety cabinet and an isolator for oncology drug reconstitution in Tunisia.

INTRODUCTION: In order to implement a centralized cytotoxic reconstitution unit (CCRU), a study was conducted to compare the implementation costs of a CCRU equipped with a cytotoxic safety cabinet (CSC) and one equipped with an isolator with negative pressure. MATERIALS AND METHODS: This study compares items such as infrastructure, air treatment and CCRU qualification costs, equipment's purchase and qualifications costs, as well as staff dressing costs. Two plans were elaborated according to the international recommendations in a way that they respond to the necessary requirements in both cases. Requests for quotes for the compared items were sent to different suppliers. RESULTS: The implementations' cost of a CCRU equipped with a CSC is cheaper than the one equipped with an isolator. The price of an isolator is much higher than a CSC; its qualification is also more expensive. However, the requirements and the costs for the air treatment and the dressing of the staff are less in the case of an isolator. The overall cost of the CCRU's implementation is approximately 1.3 times higher in the case of an isolator. However, by excluding the equipment purchase cost, the overall cost of a CSC's implementation becomes higher. CONCLUSION: For Tunisia, it seems that the CSC is the most adapted. However, this work should be completed by the comparison of the CCRU's operating costs in order to optimize the resources and figure out the cheapest system.

Emergency Biosafety Management Practice in Laboratory of Shelter Hospital.

At the end of 2019, the novel coronavirus infection outbroke in Wuhan, Hubei Province. On Feb. 2, 2020, Wuhan, as the worst-hit region, began to build "shelter hospital" rapidly to treat patients with mild illness. The shelter hospital has multiple functions such as emergency treatment, surgical treatment and clinical test, which can adapt to emergency medical rescue tasks. Based on the characteristics that shelter hospital only treats patients with mild illness, tests of shelter laboratory, including coronavirus nucleic acid detection, IgM/IgG antibody serology detection, monitoring and auxiliary diagnosis and/or a required blood routine, urine routine, C-reactive protein, calcitonin original, biochemical indicators (liver enzymes, myocardial enzymes, renal function, etc.) and blood coagulation function test etc, were used to provide important basis for the diagnosis and treatment of the disease. In order to ensure laboratory biosafety, it is necessary to first evaluate the harm level of various specimens. In the laboratory biosafety management, the harm level assessment of microorganisms is the core work of biosafety, which is of great significance to guarantee biosafety. As an emergency deployment affected by the environment, shelter laboratory must possess strong mobility. This paper will explore how to combine the biosafety model of traditional laboratory with the particularity of shelter laboratory to carry out effective work in response to the current epidemic.

Recomendaciones sobre COVID-19 para personal de salud [imagem]

Folleto de 15 tarjetas para imprimir con recomendaciones sobre COVID-19 para personal de salud.

Conexão Brasília: COVID-19, biossegurança e atenção psicossocial: desafios diários

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Lineamientos para la toma, envío y manejo de muestras provenientes de casos sospechosos inusitados, así como lineamientos de Bioseguridad en el manejo del COVID-19 / Guidelines for the collection, shipment and handling of samples from unusual suspected cases, as well as Biosafety guidelines in the management of COVID-19

Fecha de actualización: 22 de mayo 2020. Brindar los lineamientos generales para la toma de muestra, conservación y transporte para el diagnóstico de virus respiratorios, con su posterior envío al Centro Nacional de Influenza (NIC) del Laboratorio Nacional de Salud; aplicable a establecidos del nivel nacional en atención a pacientes que cumplen con la definición de caso y se tipifica como "sospechoso inusitado". Y lineamientos de bioseguridad para la toma de muestras de casos tipificados como "sospechosos inusitados" que presuntivamente contengan el virus influenza A(H5N1), A(H7N9) A(H9N2) y 2019-nCoV o cualquier otro virus proveniente de un paciente tipificado como caso Inusitado. Con aplicación a nivel nacional, en las dependencias dentro y fuera del Ministerio de Salud Pública y Asistencia Social, encargadas de la toma de muestra para el diagnóstico de Virus Respiratorios.

Requerimientos para uso de equipos de protección personal (EPP) para el nuevo coronavirus (2019-nCoV) en establecimientos de salud. Recomendaciones interinas, 2 febrero, 2020 / Requirements and technical specifications of personal protective. Interim recommendations, 2 February 2020

En diciembre de 2019, un nuevo coronavirus (2019-nCoV) fue identificado como el agente etiológico de una enfermedad respiratoria aguda severa en personas expuestas a un mercado de mariscos en Wuhan, China; • La transmisión interhumana ha sido documentada, incluso en trabajadores de salud y los procedimientos generadores de aerosoles (PGA)† pueden tener un rol en la diseminación de la enfermedad; • Hay muchas incertidumbres respecto a la historia natural de la enfermedad por el 2019-nCoV, incluyendo fuente(s), los mecanismos de transmisión, la capacidad de diseminación del virus, y la persistencia del virus en el ambiente y fómites; • Al 06 de febrero de 2020, se recomiendan las siguientes precauciones para el cuidado del pacientes sospechosos o confirmados de 2019-nCoV‡: o Para cualquier caso sospechoso o confirmado de 2019-nCoV: precauciones estándares + contacto + precauciones en la transmisión por gotitas o Para cualquier caso sospechoso o confirmado de 2019-nCoV y procedimientos generadores de aerosoles: precauciones estándares + contacto + transmisión aérea (aerosoles o núcleo de gotitas) • El uso de equipos de protección personal (EPP) por los trabajadores de salud requiere de la evaluación del riesgo relacionada a las actividades de salud; • Estas recomendaciones son preliminares y sujetas a revisión hasta que nuevas evidencias estén disponibles.

In December 2019 a novel coronavirus (2019-nCoV) was identified as the causative agent of a severe acute respiratory illness among people exposed in a seafood market in Wuhan, China; • Human-to-human transmission has been documented, including in healthcare workers, and aerosol-generating procedures (AGP)† may play a role in the spread of the disease; • There are uncertainties in the natural history of the 2019-nCoV, including source(s), transmissibility mechanisms, viral shedding, and persistence of the virus in the environment and on fomites; • As of 6 February 2020, the following precautions are recommended for the care of patients with suspected or confirmed cases of 2019-nCoV: o For any suspected or confirmed cases of 2019-nCoV: standard + contact + droplet precautions o For any suspected or confirmed cases of 2019-nCoV and AGP: standard + contact + airborne precautions • The use of personal protective equipment (PPE) by healthcare workers requires an evaluation of the risk related to healthcare-related activities; • These recommendations are preliminary and subject to review as new evidence becomes available. The figures presented in this technical recommendation are rough estimates and based upon simulation exercises on the use of PPE during previous outbreaks with similar transmission modes, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). • The number of PPE units should vary according to disease severity and the number of aerosol-generating procedures per patient. • Suspected and confirmed cases of 2019-nCoV should be isolated in adequately ventilated single rooms. When single rooms are not available, patients suspected of being infected with 2019-nCoV should be grouped together (cohort). • For each patient/day it is recommended§: o Gown ­ 25 units. o Medical mask ­ 25 units.

Hazard Group 3 agent decontamination using hydrogen peroxide vapour in a class III microbiological safety cabinet.

AIMS: This study investigated the efficacy of hydrogen peroxide vapour (HPV) at inactivating hazard group 3 bacteria that have been presented dried from their growth medium to present a realistic challenge. METHODS AND RESULTS: Hydrogen peroxide vapour technology (Bioquell) was used to decontaminate a class III microbiological safety cabinet containing biological indicators (BIs) made by drying standard working suspensions of the following agents: Bacillus anthracis (Ames) spores, Brucella abortus (strain S99), Burkholderia pseudomallei (NCTC 12939), Escherichia coli O157 ST11 (NCTC 12079), Mycobacterium tuberculosis (strain H37Rv) and Yersinia pestis (strain CO92) on stainless steel coupons. Extended cycles were used to expose the agents for 90 min. The HPV cycle completely inactivated B. anthracis spores, B. abortus, B. pseudomallei, E. coli O157 and Y. pestis when BIs were processed using quantitative and qualitative methods. Whilst M. tuberculosis was not completely inactivated, it was reduced by 4 log10 from a starting concentration of 106 colony-forming units. CONCLUSIONS: This study demonstrates that HPV is able to inactivate a range of HG3 agents at high concentrations with associated organic matter, but M. tuberculosis showed increased resistance to the process. SIGNIFICANCE AND IMPACT OF THE STUDY: This publication demonstrates that HPV can inactivate HG3 agents that have an organic load associated with them. It also shows that M. tuberculosis has higher resistance to HPV than other agents. This shows that an appropriate BI to represent the agent of interest should be chosen to demonstrate a decontamination is successful.

Consideraciones para la Atención de Urgencia Odontológica y Medidas Preventivas para COVID-19 (SARS-CoV 2) / Considerations for Emergency Dental Care and Preventive Measures for COVID-19 (SARS-CoV 2)

El siguiente artículo busca presentar diversas consideraciones para la atención odontológica a fin de disminuir riesgo de exposición al virus «Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)¼ para el profesional odontólogo. La higiene y el lavado de manos tanto de profesionales como de pacientes, es considerado uno de los puntos más críticos para reducir el contagio. Los odontólogos también deben preferir procedimientos electivos, en caso de atención de urgencias tomar medidas estrictas de bioseguridad para la protección de la piel y mucosas y considerar diferir en lo posible la atención odontológica en pacientes con signos y síntomas de Coronavirus (COVID-19).

Impacto del COVID-19 (SARS-CoV-2) a Nivel Mundial, Implicancias y Medidas Preventivas en la Práctica Dental y sus Consecuencias Psicológicas en los Pacientes / Global Impact of COVID-19 (SARS-CoV-2), Implications and Preventive Measures in Dental Practice and its Psychological Consequences in Patients

En diciembre de 2019, en China surgió un nuevo brote de neumonía la cual fue identificada como SARS-CoV-2 el cual tiene una rápida propagación al ser trasmitido principalmente mediante tos, estornudo o contacto. Presenta diversos síntomas como fiebre, tos seca y mialgia. Puede afectar a cualquier edad siendo principalmente leve y con resolución espontánea, pero en personas mayores y/o con comorbilidades puede presentar un curso severo o mortal. Para su diagnóstico es importante evaluar la presencia de fiebre, realizar una historia epidemiológica, TC de tórax y pruebas de laboratorio como RT-PCR o muestras del tracto respiratorio.Se realizó una revisión sistemática cualitativa realizando una búsqueda en las bases de datos Medline y ClinicalKey, se encontraron 72 artículos, los cuales se leyeron por completo, de ellos 16 cumplieron los criterios de inclusión y exclusión. La gran parte de las acciones odontológicas producen gotas o aerosoles, por esta razón se deben tomar medidas de protección, selección de pacientes y tipos de tratamientos para disminuir la posibilidad de infecciones en el personal de salud y pacientes, evaluar el uso de goma dique y colutorios previos a la atención, evitar instrumental generador de aerosoles, postergar atenciones electivas, tratar solamente emergencias dentales y extremar las medidas de desinfección de las instalaciones utilizando agentes biocidas efectivos contra el coronavirus. La trasmisión por fómites y aerosoles está comprobada por lo que debemos extremar precauciones. En situaciones de pandemia hay que considerar entregar un soporte psicológico a los pacientes, especialmente con patologías orales psicosomáticas las que pueden empeorar. La posibilidad de trasmisión en el periodo de recuperación no está comprobada ni descartada.

Consideraciones en la Atención Odontológica de Urgencia en Contexto de Coronavirus COVID-19 (SARS-CoV-2) / Urgency Dental Care Considerations in the Context of Coronavirus COVID-19 (SARS-CoV-2)

Los Coronavirus son una familia de virus de amplia distribución en la naturaleza presentes principalmente en los animales. El Covid-19 es la enfermedad causada por el coronavirus (SARS-CoV-2), que fue identificado y caracterizado en enero de 2020 en China. Los profesionales del área odontológica deben tomar todas las medidas de protección al tener que realizar una atención de urgencia, lavado de manos y utilización de equipos de protección personal. Para cada una de las urgencias odontológicas consideradas en la guía del Ministerio de Salud de Chile se dan recomendaciones para el actuar y posterior desechos e higienización de materiales. El objetivo de este artículo de revisión es entregar recomendaciones actualizadas y atingentes a nuestra realidad nacional a fin de disminuir las posibilidades de contagio ante la exposición inminente de pacientes sospechosos o que pudiesen presentar Covid-19.

New Post-COVID-19 Biosafety Protocols in Pediatric Dentistry

Abstract The most recent Severe Acute Respiratory Syndrome - COVID-19 - caused by coronavirus infection (SARS-CoV-2) has high-virulence transmission and direct human contagiousness by proximity. Thus, the considerable occupational risk in pediatric dentistry is evident, given the nature and form of procedures performed in an outpatient setting. Thus, the aim of this paper was to identify and contextualize technical and scientific information available to date aimed at preventing and minimizing risks for patients, caregivers and professionals. The results indicate that protective measures are being developed considering procedures according to risks and benefits, and five points stand out: 1. Regulation of resumption of elective procedures, screening and scheduling patients; 2. Restructuring clinical environment and infection control; 3. Improvement of personal protective equipment and biosafety recommendations; 4. Maximization of the use of non-invasive techniques, use of high-powered dental suction, and absolute isolation of the operative field; and 5. Minimization of the use of air-water syringe, dental spittoon and high-speed handpiece. The measures to be taken require reflection for the restart of a "new clinical practice", especially aiming at behavioral and structural changes regarding operational biosafety.

Dental Care and the COVID-19 Pandemic: The Precautionary Principle and the Best Available Evidence

Abstract The precautionary principle is part of evidence-based healthcare and is used both preventively and therapeutically when there is no available evidence about how to manage problems/diseases/conditions that are especially life-threatening. However, since it is not always based in the most qualified evidence, it is frequently questioned. The emergence of a highly contagious disease, with increased levels of morbimortality, an acute respiratory syndrome, the so called Coronavirus Disease 2019 (COVID-19), led health professionals to look for the best alternatives to save lives. In this sense, the precautionary principle was evocated. The aim of this paper is to make a reflection about the precautionary principle, the dental profession and COVID-19. It is important to have in mind that in such a disease, guidelines, protocols and approaches can change very fast, since a continuous evaluation of all policies is mandatory. During the pandemic, elective procedures may be restricted, but international organizations removed the recommendation to postpone elective procedures. Clinicians are advised to be updated about their local current policies. On the other hand, there are cases in which in-office dental care is unavoidable, such as individuals with pain, spontaneous bleeding and dental trauma. Biosafety is upmost importance when seeking patients during pandemic. In this sense, it was concluded that precautionary principle should be, therefore, used. However, caution needs to be taken and continuous surveillance necessary.

Design Strategies for Biocontainment Units to Reduce Risk During Doffing of High-level Personal Protective Equipment.

BACKGROUND: Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). METHODS: In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. RESULTS: The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P = .004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P = .04), and participants reported a similar workload in the redesigned doffing layout (P = .43). CONCLUSIONS: Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE.

Evaluating containment effectiveness of A2 and B2 biological safety cabinets.

PURPOSE: This study investigates the use of a canopy-connected recirculating class II type A2 biological safety cabinet (BSC) as an alternative to the B2 when preparing volatile, sterile compounded preparations. Selection of the appropriate BSC for processes that use subgram levels of volatile chemicals is difficult due to a lack of quantitative containment evidence by cabinet type. There is a perception that hazardous compounding must be done in a B2 cabinet due to the potential for vapors, and this study seeks to challenge that perception. METHODS: In total, 5 tests, 3 prequalification tests and 2 containment capability tests, were conducted on a single cabinet of each type at sterile compounding pharmacies. Prequalification tests were performed to verify that each BSC was operating properly. Each cabinet was certified to NSF-ANSI 49-2016, particle counted per ISO 14644-1:1999, and subjected to a qualitative video smoke study. Once these tests confirmed the expected working conditions, 2 containment capability tests were conducted. The containment testing included tracer gas testing per ASHRAE 110:2016 section 8.1.1 through 8.1.13, and cyclophosphamide sampling during sterile compounding of the drug material. RESULTS: Both cabinets passed all the prequalification tests. During the ASHRAE tracer gas testing the A2 cabinet was able to contain a tracer gas 92% to 160% as effectively as the B2 cabinet depending on the position of the gas ejection. During sterile compounding the airborne cyclophosphamide sampling captured samples of less than 1.0 ng at all locations for both the A2 and B2 cabinets. CONCLUSION: The data generated from this study demonstrate that use of an A2 for hazardous compounding can provide a comparable level of safety for the environment, users, and product while having less stringent airflow requirements relative to a B2. The simpler requirements for an A2 make them an appealing alternative as they have the potential to reduce the overall operating costs associated with a compounding pharmacy while maintaining safe levels of containment.