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1.
Cochrane Database Syst Rev ; 5: CD011621, 2020 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-32412096

RESUMEN

BACKGROUND: In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES: To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA: We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS: Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS: We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.


Asunto(s)
Infecciones por Coronavirus , Fiebre Hemorrágica Ebola , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Equipo de Protección Personal , Neumonía Viral , Síndrome Respiratorio Agudo Grave , Betacoronavirus , Líquidos Corporales , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Guantes Protectores , Personal de Salud , Fiebre Hemorrágica Ebola/prevención & control , Fiebre Hemorrágica Ebola/transmisión , Humanos , Control de Infecciones/métodos , Oportunidad Relativa , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Ropa de Protección , Dispositivos de Protección Respiratoria , Síndrome Respiratorio Agudo Grave/prevención & control , Síndrome Respiratorio Agudo Grave/transmisión
2.
Artículo en Inglés | MEDLINE | ID: mdl-32325718

RESUMEN

Healthcare workers exposed to coronavirus (COVID-19) may not have adequate access to personal protective equipment (PPE), safety procedures, and diagnostic protocols. Our objective was to evaluate the reality and perceptions about personal safety among healthcare workers in Latin America. This is a cross-sectional, online survey-based study administered to 936 healthcare professionals in Latin America from 31 March 2020 to 4 April 2020. A 12-item structured questionnaire was developed. A total of 936 healthcare workers completed the online survey. Of them, 899 (95.1%) were physicians, 28 (2.9%) were nurses, and 18 (1.9%) were allied health professionals. Access to protective equipment was as follows: gel hand sanitizer (n = 889; 95%), disposable gloves (n = 853; 91.1%), disposable gowns (n = 630; 67.3%), disposable surgical masks (785; 83.9%), N95 masks (n = 516; 56.1%), and facial protective shields (n = 305; 32.6%). The vast majority (n = 707; 75.5%) had access to personal safety policies and procedures, and 699 (74.7%) participants had access to diagnostic algorithms. On a 1-to-10 Likert scale, the participants expressed limited human resources support (4.92 ± 0.2; mean ± SD), physical integrity protection in the workplace (5.5 ± 0.1; mean ± SD), and support from public health authorities (5.01 ± 0.12; mean ± SD). Healthcare workers in Latin America had limited access to essential PPE and support from healthcare authorities during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Personal de Salud/psicología , Máscaras , Pandemias/prevención & control , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/prevención & control , Ropa de Protección/provisión & distribución , Administración de la Seguridad , Adolescente , Adulto , Betacoronavirus , Coronavirus , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Guantes Protectores , Humanos , América Latina/epidemiología , Persona de Mediana Edad , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral/epidemiología , Ropa de Protección/estadística & datos numéricos , Adulto Joven
4.
Artículo en Alemán | MEDLINE | ID: mdl-32274773

RESUMEN

COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 - 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 - 2%. Protecting health care workers is of paramount importance in order to prevent hospital acquired infections. Therefore, during all procedures associated with aerosol production, a personal safety equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and an adequate management of organ failures are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Oxigenación por Membrana Extracorpórea/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Medicina Basada en la Evidencia , Humanos , Pandemias , Ropa de Protección , Respiración Artificial/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad
8.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-32210421

RESUMEN

Due to the nature of their profession, health care personnel (HCP) have always been easy targets for transmission of communicable diseases like COVID-19. Shielding HCPs is of consequential significance in ensuring continued health care for the whole population in addition to reducing further spread. Close contact, repeated contact and prolonged contact are unavoidable in the intensive care (IC) environment. It is not uncommon for IC-HCPs to get carried away during an emergent situation, such as that posed by a suddenly deteriorating patient, and forgo the protective barriers that protect them from contracting a communicable infection. Some notable precautionary measures are mentioned below. This is by no means an exhaustive list.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Personal de Salud , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Neumonía Viral , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Cuidados Críticos , Desinfección , Desinfección de las Manos , Humanos , Higiene , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Ropa de Protección
11.
Neuquén; s.n; 26 mar. 2020.
No convencional en Español | LILACS, BRISA/RedTESA | ID: biblio-1094952

RESUMEN

INTRODUCCIÓN: En epidemias de enfermedades altamente infecciosas, como la enfermedad del virus del Ébola o el síndrome respiratorio agudo severo, los trabajadores de la salud tienen un riesgo mucho mayor de infección que la población en general, debido a su contacto con el cuerpo, fluido y aerosoles generados por los pacientes. Las precauciones de contacto medianteequipos de protección personal (EPP) pueden reducir el riesgo, pero existen distintos tipos y no está claro en el contexto de la pandemia por COVID-19 si el mameluco o coverallprotege mejor que otros EPP. Surgen en el Sistema de Salud Pública de la Provincia deNeuquén dudas sobre, aspectos de seguridad, eficacia y conveniencia, cuál es la mejorforma de quitarlo y cómo asegurarse de que los trabajadores de salud los usen según las instrucciones. METODOLOGÍA: Un equipo multidisciplinario sin conflictos de interés realizó una búsqueda bibliográfica no sistemática, clasificó y analizó la evidencia disponible. Priorizó Revisiones Sistemáticas, Guías de Práctica Clínica basadas en la evidencia y recomendaciones de OMS-OPS. RESULTADOS: Una revisión sistemática de Cochrane actualizada no encuentra evidencias contundentes de beneficios de los mamelucos comparado con el EPP standard. La calidad de la evidencia es muy baja. Los documentos actualizados de OMS-OPS no recomiendan los mamelucos como parte del EPP. Algunas sociedades científicas y organimos estatales los mencionan em sus recomendaciones (CDC, GPC China) y otras no los mencionan. Expertos consultados mencionan preocupación por la forma de colocarlo y retirarlo, la necesidad de entrenamiento, la incomodidad que podría ocasionar al trabajador de salud. CONCLUSIONES Y RECOMENDACIONES: La evidencia a favor o en contra de los mamelucos es de muy baja calidad y no arroja resultados significativos. Existirían preocupaciones sobre la incomodidad y la necesidad de entrenamiento para utilizarlo en forma segura por los trabajadores de salud. Los costos y factibilidad de gestionarlo en número adecuado en el contexto actual hacen pensar que su provisión podría ser sumamente dificultosa.


Asunto(s)
Humanos , Neumonía Viral/prevención & control , Ropa de Protección/normas , Personal de Salud , Infecciones por Coronavirus/prevención & control , Argentina , Evaluación de la Tecnología Biomédica
13.
Int J Biometeorol ; 64(3): 485-499, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32016640

RESUMEN

Evaporative cooling is the critical heat dissipation mechanism for working individuals wearing thermal protective clothing in hot environments. However, until now, there is no knowledge on garment size design for evaporative cooling optimization, especially when the human body is in movements. In this study, to understand the dynamic effect of garment size on evaporative cooling, we performed experiments on a sweating thermal manikin with seven garment sizes and three walking speeds. The evaporative cooling of global and local manikin body with this wide range garment sizes was present. Results demonstrated that the effect of garment size on evaporative cooling depended on the walking speed. At lower walking speeds, the global evaporative cooling tended to decrease with greater garment size, while at higher walking speeds, the global evaporative cooling tended to increase with greater garment size. Similarly, according to effects of garment size on local evaporative cooling, body segments could be divided into three categories for evaporative cooling optimization. Further, we analyzed factors which influenced the positive effect of walking speed on the evaporative cooling. Results showed that, for most cases, the increase of evaporative cooling caused by walking showed positive linear relationship with the garment size. Further increase of walking speed led to a greater increase rate of evaporative heat loss for body segments with the small air gap. This study provides insights into clothing local characteristics of evaporative cooling with different garment sizes under dynamic conditions and may help clothing design to optimize the evaporative cooling of working individuals in hot environments.


Asunto(s)
Maniquíes , Caminata , Regulación de la Temperatura Corporal , Calor , Humanos , Ropa de Protección , Sudoración
14.
Sci Total Environ ; 714: 136819, 2020 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-31986393

RESUMEN

The problems of determining the protective properties of barrier materials used for the production of body surface protection products of an isolative type are very actual. These garments are expected to have long-term resistance against permeation of toxic substances. The paper deals with the study of the effect of organic solvent vapours on the changes in protective properties of selected anti-gas protective garments commonly used by the North Atlantic Treaty Organization armed forces. Permeation measurements of selected gases with integral permeameter were performed to verify their barrier properties, surface changes after exposure to selected solvents by using a 3D optical profilometer, permeation measurements for vapours of these solvents with differential permeameter, and experimental simulating the possible influence of barrier properties of garments within permeation of air. It has been shown that in the case of gases, the permeability of the studied materials increases with decreasing kinetic diameter of the penetrant molecule used. In the case of acetonitrile and isooctane vapours, permeability increased with increasing vapour concentration due to interactions between polymeric materials and molecules of organic compounds. The permeation measurements of pure vapours and air/vapour mixtures indicate that the level of interactions between the molecules of the penetrant and the material of the protective garment is not strong enough to degrade the material of the garment in such a way as to allow a greater penetration of the pollutants through it. The results of permeation experiments for gases and organic vapours showed very good barrier properties of studied chemical isolated garments.


Asunto(s)
Personal Militar , Gases , Humanos , Permeabilidad , Ropa de Protección , Solventes
18.
J Dairy Sci ; 103(1): 846-851, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31733865

RESUMEN

Ectoparasitic stable flies (Stomoxys calcitrans [L.]), horn flies (Haematobia irritans [L.]), and face flies (Musca autumnalis De Geer) negatively affect dry matter intake, milk production, and health of pastured dairy cows. These flies cause fly avoidance behaviors and are a major welfare concern for dairy producers. The objective of this study was to evaluate the effects of mesh Shoofly Leggins (Stone Manufacturing & Supply, Kansas City, MO) on fly avoidance behaviors and numbers of flies attacking pastured dairy cows. In a crossover design, lactating dairy cows (n = 80) were randomly assigned to groups with and without leggings (Shoofly Leggins worn on all legs). All cows were managed in one group. Cows were observed for 2-wk periods, and then treatments were reversed in the next 2-wk interval. Counts of stable flies, horn flies, and face flies on all cows were recorded twice daily (once in morning per cow: 0930 to 1230 h; and once in the afternoon per cow: 1330 to 1630 h), 3 times per wk on Tuesday, Wednesday, and Thursday of each week during the study period. The total number of flies per cow was greater on cows with leggings than cows without leggings. The number of horn flies per cow was greater on cows in with leggings (26.4 flies/side) compared with cows without leggings (24.1 flies/side). Stable fly numbers were similar for cows with and without leggings (12.8 flies/leg). A random subset of 20 focal cows per group was observed during 5-min intervals to record frequencies of 4 behaviors: leg stomps, head tosses, skin twitches, and tail swishes. Counts of head tosses (2.6 vs. 3.1), skin twitches (20.9 vs. 19.6), and tail swishes (21.3 vs. 19.3) were similar for cows without leggings versus cows with leggings, respectively. However, foot stomps were 39% lower for cows with leggings compared with cows without leggings, and leg stomps were 26% higher in the afternoon than in the morning (2.9 vs. 2.4, respectively). A positive correlation was observed between stable and horn flies and all insect avoidance behaviors. Numbers of stable flies were 1.5 times greater in the afternoon than in the morning. The results of this study indicated that flies were associated with cow fly avoidance behaviors regardless of the use of leggings, but leggings effectively reduced foot stomps by 39%, so their use may provide some relief from stable fly injury to pastured dairy cows.


Asunto(s)
Enfermedades de los Bovinos/parasitología , Infestaciones Ectoparasitarias/veterinaria , Muscidae , Ropa de Protección/veterinaria , Animales , Reacción de Prevención , Conducta Animal , Bovinos , Enfermedades de los Bovinos/prevención & control , Estudios Cruzados , Infestaciones Ectoparasitarias/prevención & control , Femenino , Lactancia
19.
Diving Hyperb Med ; 49(4): 266-275, 2019 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-31828745

RESUMEN

INTRODUCTION: The purpose of the study was to evaluate the thermal protection provided by a 2-3 mm surfing wet suit during at least two hours of fin diving in shallow water with a temperature of 16-20°C. We examined the effect of wearing the suit while diving in cold water on cognitive performance, muscle strength, and hand motor function. METHODS: Subjects were six male well-trained rebreather divers, 19-23 years old, acclimatised to cold. They attended the laboratory on three separate occasions, when we conducted the experiment at one of three temperatures, 16, 18, and 20°C. Core temperature (gastrointestinal system), skin temperature, oxygen consumption, and cold perception were evaluated during the test. Before and immediately after the dives, subjects performed a series of cognitive, manual dexterity, and muscle strength tests. RESULTS: Core temperature decreased by 0.35-0.81°C over the two hours at all three water temperatures. No subject reached a core temperature below 35°C. The decrease in upper body skin temperature during the two hour dive ranged between 5.97 and 8.41°C (P < 0.05). Two hours diving in 16-20°C water resulted in a significant increase in the time taken to perform the task of unlinking and reassembling four shackles (∼30% longer, P < 0.05). No effect was found on the cognitive or muscle strength tests. CONCLUSIONS: A 2-3 mm wet suit provides adequate thermal protection in trained and cold-acclimatised young males engaged in active diving in shallow water with a temperature of 16°C and above.


Asunto(s)
Cognición/fisiología , Frío , Buceo , Fuerza Muscular/fisiología , Ropa de Protección , Regulación de la Temperatura Corporal , Buceo/fisiología , Mano/fisiología , Fuerza de la Mano/fisiología , Humanos , Masculino , Destreza Motora/fisiología , Consumo de Oxígeno , Temperatura , Agua
20.
Artículo en Inglés | MEDLINE | ID: mdl-31581620

RESUMEN

Postal delivery workers have substantial sun exposure. In the United Kingdom (UK) a high proportion of workers possesses a sun sensitive skin type. This population is at elevated risk for skin cancer, yet uptake of sun safety practices is low. Studies are needed to identify the underlying factors that contribute to the uptake of occupational sun safety practices that may be targeted during behavior change interventions. This study integrated the Theory of Planned Behavior (TPB) and the Transtheoretical Model's stages of change (SoC) as guiding frameworks to identify underlying beliefs that influence UK postal delivery workers' uptake of occupational sun safety practices. Thirty-four workers participated in semi-structured interviews that used the SoC to establish current receptiveness to and adoption of two sun safety practices (using sunscreen of at least sun protection factor (SPF) 30 on exposed skin and wearing a wide-brimmed hat when working outdoors in the summer). Beliefs underlying current practices were elicited in accordance with the TPB and stratified by the SoC. For sunscreen use and wearing a wide-brimmed hat, 64% and 3% of participants were in the action or maintenance SoC, respectively. Behavioral and control beliefs differed by SoC, with those in the earlier stages more likely than those in the latter stages to report negative attitudes to, and difficulty enacting, sun safety practices. Normative beliefs concerning the views of colleagues and employers towards sunscreen were relatively consistent across the SoC. This study highlights the need for tailored and targeted behavior change interventions. The SoC-stratified accounts of the influence of TPB components on behavior provide a basis for bespoke interventions that reflect inter-individual and inter-practice differences in their working mechanisms.


Asunto(s)
Exposición Profesional/prevención & control , Ropa de Protección , Neoplasias Cutáneas/prevención & control , Luz Solar/efectos adversos , Protectores Solares/administración & dosificación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Servicios Postales , Reino Unido
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