Infection and the use of personal protective equipment among Primary Health Care workers during the COVID-19 pandemic.

OBJECTIVE: to analyze the frequency and associated risk factors for COVID-19 infection and the availability of Personal Protective Equipment used by primary healthcare workers. METHOD: a cross-sectional study was conducted over six months in Rio Grande do Sul. Descriptive analysis was performed, with the comparison of independent samples using Pearson's Chi-square test and Fisher's Exact test (p<.05). RESULTS: the study included 206 (27%) healthcare workers who presented COVID-19 symptoms. There was a statistical association for the following variables: availability of surgical masks (p=.003), seeking information on the correct use of personal protective equipment (p=.045), having attended people with flu-like syndrome (p=.024), and believing that the highest risk of contamination is when attending a patient positive for coronavirus disease (p=.001). CONCLUSION: the availability of personal protective equipment is indispensable for COVID-19 prevention, with special emphasis on the use of surgical masks. Furthermore, the study highlighted the importance of providing Personal Protective Equipment in conjunction with guidance on its use. HIGHLIGHTS: (1) Highlighted impacts on the distribution of PPE necessary for worker safety.(2) Emphasized the need for training and education regarding the use of PPE.(3) Found significance regarding the availability of surgical masks.(4) Identified the need for further research on health safety topics.(5) Revealed a high incidence of symptomatic workers and positive cases of COVID-19.

Factors underlying the high occupational risk of healthcare personnel for COVID-19 infection.

Crispim et al. demonstrated the independent risk factors for acquiring COVID-19 among healthcare personnel. They also showed the importance of infection prevention training to avoid acquiring COVID-19 in this population. OBJECTIVE: To verify the rate of COVID-19 infection among healthcare personnel at high and low risk of COVID-19 infection and identify the underlying risk factors. METHODS: This cross-sectional study was conducted between December 1, 2020 and February 28, 2021. Associations were verified between the levels of risk (high or low) of occupational COVID-19 infection and participant characteristics using the World Health Organization risk assessment questionnaire and adjusted using logistic regression models in single and multiple approaches. RESULTS: Of the 486 participants, 57.4% were classified as having a high occupational risk for SARS-CoV-2 infection, with a diagnosis rate of 12.1%. The factors identified in the multivariate analysis for high occupational risk were age up to 29 years (odds ratio [OR] = 2.7, 95% confidence interval [95%CI] = 1.63-4.47), monthly family income greater than eight times the basic salary (OR= 1.8, 95%CI= 1.07-3.16), and healthcare personnel who did not participate in initial training to work in the area of patients with COVID-19 infection (OR= 2.39, 95%CI= 1.53-3.75). CONCLUSION: Encouraging training for occupational infection prevention is very important to reduce the impact of infectious diseases on healthcare personnel, especially young health professionals. COVID-19 infection among healthcare personnel has impacted the workforce in hospitals. Knowledge of the risk factors for COVID-19 infection is important for disease prevention measures. Failure to train healthcare personnel is an important risk factor for acquiring COVID-19.

Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study.

BACKGROUND: The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs). AIM: To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method. METHODS: This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities. FINDINGS: Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure. CONCLUSIONS: This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.

Infecciones transmitidas por pacientes al personal de salud. Síntesis de evidencia

El personal de salud es un eslabón importante en la cadena de transmisión de microorganismos patógenos de diversa índole; por ejemplo, pueden contagiarse y enfermar o convertirse en una fuente secundaria de transmisión. Algunas de estas consecuencias se evitan mediante vacunas o profilaxis farmacológica, pero en otros casos la prevención depende exclusivamente de la aplicación correcta y adecuada de las medidas de prevención y control de infecciones. Esta publicación aborda los riesgos y consecuencias que tiene para el personal de salud la exposición ocupacional a microorganismos patógenos en establecimientos de salud. Su objetivo es sensibilizar a quienes dirigen esos establecimientos sobre la necesidad de establecer una adecuada capacidad de respuesta a brotes, casos aislados o toda forma de presentación que conlleve riesgos para el personal. También es útil para que los equipos de dirección se mantengan en estado de alerta frente a casos que constituyan una posible fuente de contagio (que en numerosas ocasiones se reconocen de forma tardía) y adopten medidas acordes de prevención y control de infecciones de manera oportuna. En esta síntesis de evidencia se incluyen microorganismos que han afectado distintas regiones del mundo, a fin de presentar una visión panorámica de todas las situaciones posibles, que pueden ir desde la exposición a un caso importado de un paciente único con una fiebre hemorrágica hasta una pandemia.

Infecciones transmitidas por pacientes al personal de salud. Síntesis de evidencia / Infections transmitted by patients to health personnel. Evidence synthesis

La presente publicación aborda los riesgos y consecuencias que tiene para el personal de salud la exposición ocupacional a microorganismos patógenos en establecimientos de salud. Su objetivo es sensibilizar a quienes dirigen esos establecimientos sobre la necesidad de establecer una adecuada capacidad de respuesta a brotes, casos aislados o toda forma de presentación que conlleve riesgos para el personal. También es útil para que los equipos de dirección se mantengan en estado de alerta frente a casos que constituyan una posible fuente de contagio (que en numerosas ocasiones se reconocen de forma tardía) y adopten medidas acordes de prevención y control de infecciones de manera oportuna. En esta síntesis de evidencia se incluyen microorganismos que han afectado distintas regiones del mundo, a fin de presentar una visión panorámica de todas las situaciones posibles, que pueden ir desde la exposición a un caso importado de un paciente único con una fiebre hemorrágica hasta una pandemia

The Impact of Biosecurity on Biological and Psychosocial Risks for Health Workers of COVID Hospitals in Guadalajara, Jalisco, Mexico.

BACKGROUND: Some data support that health care workers (HCWs) must have sufficient and good quality personal protective equipment (PPE) and the necessary training to manage COVID patients to avoid contagion that can lead to death. The objective of this study was to determine the relationship between biosafety on the biological risks of SARS-CoV-2 and risks of fatigue, anxiety, or depression in health workers who care for patients in COVID hospitals, from September 2020 to August 2021. MATERIAL AND METHODS: The questionnaire used in this study (Q6S64I) consisted of 6 spheres: Sociodemographic aspects, working conditions; Personal Protection Equipment; safety and health; training and knowledge about COVID-19, the form of transport, and personal health conditions. The answers were online. The Goldberg questionnaire (EADG) measures anxiety and depression, and the questionnaire measures fatigue (Barrientos-Gutiérrez et al.) (PSSF). RESULTS: In total, 76.5% of the HCWs were doctors, 25.2% worked in the emergency services, 79.3% received PPE from their institution, 82.9% cared for COVID-19 patients, and 27.9% tested positive for COVID-19. The PPE provided by the employer was 80%, but the quality was deficient, insufficient, and associated with a relative risk of 4.6. A total of 99% acquired better PPE on their own. The exposure to COVID-19 and the surgical mask provided by the institution had an associated relative risk of 2.8 for the HCWs. A total of 39% of the HCWs reported being calm. CONCLUSIONS: PPE, risk exposure, and safety at work were significantly associated with drowsiness and heaviness, difficulty concentrating, anxiety, and depression.

Saúde mental e atuação de psicólogos hospitalares brasileiros na pandemia da covid-19 / Health and works of brazilian hospital psychologists in the covid-19 pandemic / Salud mental y actuación de psicólogos en hospitales brasileños en la pandemia del covid-19

Em março de 2020 a situação causada pela covid-19 foi elevada à categoria de pandemia, impactando de inúmeras formas a vida em sociedade. O objetivo deste estudo foi compreender os impactos da pandemia na atuação e saúde mental do psicólogo hospitalar, profissional que atua nos espaços de saúde e tem experienciado mais de perto o sofrimento dos doentes e dos profissionais de saúde frente à covid-19. Trata-se de um estudo exploratório-descritivo com 131 psicólogos que atuam em hospitais. Os profissionais foram convidados a participar através de redes sociais e redes de contatos das pesquisadoras, utilizando-se a técnica Bola de Neve. Foram utilizados dois questionários, disponibilizados na plataforma Google Forms, um abordando os impactos da pandemia sentidos pelos profissionais e outro referente ao sofrimento psíquico. Os dados foram analisados a partir de estatísticas descritivas e inferenciais. Foram observados impactos na atuação de quase a totalidade dos participantes, constatada a necessidade de preparação dos profissionais para o novo cenário, a percepção de pouco apoio institucional e quase metade da população estudada referiu-se a sintomas de sofrimento psíquico considerável desde o início da pandemia. É fundamental dar atenção a sinais e sintomas de sofrimento psíquico, procurando evitar o adoecimento de uma categoria profissional que se encontra na linha de frente do combate aos danos psicológicos da pandemia e cuja própria saúde mental é pouco abordada na literatura.(AU)

In March 2020, the COVID-19 pandemic breakout hugely impacted life in society. This study analyzes how the pandemic impacted hospital psychologists' mental health and performance, professional who more closely experienced the suffering of patients and health professionals in this period. An exploratory and descriptive study was conducted with 131 hospital psychologists. Professionals were invited to participate through the researchers' social and contact networks using the Snowball technique. Data were collected by two questionnaires available on the Google Forms platform, one addressing the impacts felt by professionals and the other regarding psychic suffering, and analyzed by descriptive and inferential statistics. Results showed that almost all participants had their performance affected by the need to prepare for the new scenario, the perceived little institutional support. Almost half of the study sample reported considerable psychological distress symptoms since the beginning of the pandemic. Paying attention to signs and symptoms of psychic suffering is fundamental to avoid compromising a professional category that is on the front line of combating the psychological damage caused by the pandemic and whose own mental health is little addressed by the literature.(AU)

En marzo de 2020, la situación provocada por el COVID-19 se caracterizó como pandemia e impactó el mundo de diversas maneras. El objetivo de este estudio fue comprender los impactos de la pandemia en la salud mental y la actuación del psicólogo en los hospitales, uno de los profesionales que trabaja en espacios sanitarios y que ha experimentado más de cerca el sufrimiento de pacientes y profesionales sanitarios frente al COVID-19. Este es un estudio exploratorio descriptivo, realizado con 131 psicólogos que trabajan en hospitales. Los profesionales recibieron la invitación a participar a través de las redes sociales y redes de contactos de las investigadoras, mediante la técnica snowball. Se utilizaron dos cuestionarios disponibles en la plataforma Google Forms: uno sobre los impactos de la pandemia en los profesionales y el otro sobre el sufrimiento psíquico. Los datos se analizaron a partir de estadísticas descriptivas e inferenciales. Se observaron impactos en el trabajo de casi todos los participantes, la necesidad de preparación de los profesionales para este nuevo escenario, la percepción de poco apoyo institucional, y casi la mitad de la población estudiada reportaron sentir síntomas de considerable angustia psicológica desde el inicio de la pandemia. Es esencial prestar atención a los signos y síntomas del sufrimiento psíquico, buscando evitar la enfermedad de una categoría profesional que está a la vanguardia de la lucha contra el daño psicológico de la pandemia y cuya propia salud mental se aborda poco en la literatura.(AU)

Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados.

Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.

Use of recommended personal protective equipment among Brazilian health professionals during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is one of the biggest health crises in the world and the use of personal protective equipment (PPE) is significant measures to prevent the transmission of SARS-CoV-2. However, PPE needs to be used properly by healthcare professionals. OBJECTIVE: To analyze the use of PPE among Brazilian health professionals and associated factors during a period of the COVID-19 pandemic. METHODS: An analytical cross-sectional study was carried out from October to December 2020. For data collection, the respondent-driven sampling technique was used, adapted for social media, with a link to an online survey form. RESULTS: The study considered 12,086 Brazilian health professionals. Most (69%) used PPE recommended for the care of patients with suspected or diagnosed COVID-19. Factors associated with the use of PPE were: working in an Intensive Care Unit (ICU) or in a field hospital, receiving training, being provided with sufficient, high-quality PPE by the workplace and being an odontologist compared to nursing professionals. For procedures that generate aerosols in the context of COVID-19, 54.1% of them used the recommended PPE, the associated factors were: being married or in a stable relationship compared to a single/divorced professional, working in an ICU, being offered training, providing sufficient, high-quality PPE, and being an odontologist compared to nursing professionals. CONCLUSIONS: For the care of patients with COVID-19, 69% of health professionals used PPE properly, and several factors interfered with the use of this equipment.

Trabajadores de la salud contagiados de SARS-CoV-2 durante sus funciones asistenciales en una institución hospitalaria / Health workers contaminated with SARS-CoV-2 during their assistance functions in a hospital institution

Introducción: La preservación de los profesionales sanitarios es siempre prioritaria, especialmente en situaciones de epidemia. Objetivo: Caracterizar a trabajadores de la salud que enfermaron de COVID-19 durante el ejercicio de su profesión. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de serie de casos, con recogida de la información en forma retrospectiva, en 12 trabajadores del Hospital Docente Infantil Sur Dr. Antonio María Béguez César de Santiago de Cuba, quienes se contagiaron del SARS-CoV-2 mientras realizaban sus funciones asistenciales en el primer semestre del año 2021. Resultados: En la serie predominaron el sexo femenino (91,7 %) y el grupo etario de 30 a 39 años (33,3 %); la mayoría de los trabajadores laboraban en los servicios de Miscelánea (41,7 %) y Microbiología (16,7 %) y fundamentalmente eran médicos. También sobresalieron los que no tenían antecedentes patológicos personales (66,7 %) y los que no mostraron complicación alguna asociada al proceso infeccioso. En cuanto a los factores de riesgo laboral, todos habían estado expuestos al virus y algunos habían tenido contacto con presuntos infectados o con pacientes que padecían la enfermedad. Entre los síntomas de la COVID-19 que les aquejaban resultaron más frecuentes la fiebre, la tos, la cefalea y el malestar general. Conclusiones: El bajo número de trabajadores que contrajo el coronavirus durante su desempeño asistencial en esa etapa se debió, en gran medida, a la eliminación de brechas en el cumplimiento de las normas de bioseguridad establecidas para la atención a los presuntos infectados por el SARS-CoV-2 y a los enfermos de la COVID-19, así como a las prácticas seguras del personal sanitario.

Introduction: The preservation of health professionals is always high-priority, especially in epidemic situations. Objective: To characterize health workers that got sick with COVID-19 during the exercise of their profession. Methods: An observational, descriptive and cross-sectional serial cases study with retrospective collection of the information was carried out in 12 workers of Dr. Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba who caught the SARS-CoV-2 while they carried out their assistance functions in the first semester of the year 2021. Results: In the series there was a prevalence of the female sex (91.7 %) and the 30 to 39 age group (33.3 %); most of the workers worked in the miscellany (41.7 %) and microbiology services (16.7 %) and they were mainly doctors. Those that didn't have personal pathological history were also notable (66.7 %) and those that didn't show any complication associated with the infectious process. As for the labor risk factors, all had been exposed to the virus and some had had contact with presumed infected or with patients that suffered from the disease. Among the symptoms of the COVID-19 that they suffered, fever, cough, migraine and diffuse discomfort were more frequent. Conclusions: The few number of workers that caught the coronavirus during their assistance performance in that phase was to a large extent due to the elimination of breaches in the execution of biosecurity norms established for the care to the presumed infected by the SARS-CoV-2 and to the sick persons of the COVID-19, as well as to the secure practices of the health staff.

Control and Prevention of SARS-CoV-2 Outbreaks among Healthcare Workers from 129 Healthcare Facilities in Mexico.

Few reports have shared the workflows to reduce SARS-CoV-2 infections among risk groups, including healthcare workers (HCWs). This study describes an occupational health program implemented to reduce the incidence of COVID-19 and establishes a back-to-work algorithm in HCWs of 129 Salud Digna outpatient care clinics in Mexico. This program was composed of training plans, screening SARS-CoV-2 infections, the containment of infections, follow-up COVID-19 cases, and continuing supervision in addition to the steady supply and training for the correct use of PPE. From 16 April 2020 to 15 April 2021, 7376 individuals were enrolled, of which 423 were excluded because they did not meet the inclusion criteria or refused the follow-up. In the cohort studied, we found a COVID-19 incidence of 35.4% (2610 individuals), lower hospitalization (0.11%), ICU (0.04%) and lethality rate (0.04%). Additionally, 85.9% of COVID-19 cases tested negative for SARS-CoV-2 after 14 days of the first positive test with an average isolation time of 26-33 days. Finally, 99% of people received personal protective equipment and adequate training to use it. Our results show that the program implemented reduced the hospitalization ICU admission and lethality in HCWs; we consider this workflow to help other workplaces offer safe conditions for HCWs and patients.

Assessment of Attentional Functioning in Health Professionals of a Brazilian Tertiary Referral Hospital for COVID-19.

This study is aimed at assessing differences in basic attentional functioning between substantial and minimal work-related exposure to COVID-19 patients in professionals working in a tertiary referral hospital in Rio de Janeiro, Brazil. Therefore, hospital employees performed a Continuous Visual Attention Test. This test consisted of a 90-second Go/No-Go task with 72 (80%) targets and 18 (20%) nontargets. For each participant, reaction time and intraindividual variability of reaction times of all correct target responses, as well as the number of omission and commission errors, were evaluated. Participants were divided into 2 groups based on their exposure to COVID-19 patients (substantial versus minimal exposure). The substantial exposure group consisted of participants with 24 hours/week or more direct contact with COVID-19 patients. This cut-off was based on the clear division between professionals working and not working with COVID-19 patients and considered that 12-hour and 24-hour daily shifts are common for hospital employees in Brazil. A MANCOVA was performed to examine between-group differences, using age, sleep quality, sex, education level, previous COVID-19 infection, and profession as covariates. Of 124 participants, 80 had substantial exposure and 44 had minimal exposure to COVID-19. The overall MANCOVA reached statistical significance (P = 0.048). Post hoc ANCOVA analysis showed that the substantial exposure group had a statistically significantly higher intraindividual variability of reaction time of all correct target responses (P = 0.017, Cohen's δ = -0.55). This result remained after removing those with a previous COVID-19 infection (P = 0.010, Cohen's δ = -0.64) and after matching groups for sample size (P = 0.004, Cohen's δ = -0.81). No other variables reached statistical significance. Concluding, hospital professionals with a substantial level of exposure to patients with COVID-19 show a significant attention decrement and, thus, may be at a higher risk of accidental SARS-CoV-2 infection.

Potential application of novel technology developed for instant decontamination of personal protective equipment before the doffing step.

The use of personal protective equipment (PPE) has been considered the most effective way to avoid the contamination of healthcare workers by different microorganisms, including SARS-CoV-2. A spray disinfection technology (chamber) was developed, and its efficacy in instant decontamination of previously contaminated surfaces was evaluated in two exposure times. Seven test microorganisms were prepared and inoculated on the surface of seven types of PPE (respirator mask, face shield, shoe, glove, cap, safety glasses and lab coat). The tests were performed on previously contaminated PPE using a manikin with a motion device for exposure to the chamber with biocidal agent (sodium hypochlorite) for 10 and 30s. In 96.93% of the experimental conditions analyzed, the percentage reduction was >99% (the number of viable cells found on the surface ranged from 4.3x106 to <10 CFU/mL). The samples of E. faecalis collected from the glove showed the lowest percentages reduction, with 86.000 and 86.500% for exposure times of 10 and 30 s, respectively. The log10 reduction values varied between 0.85 log10 (E. faecalis at 30 s in glove surface) and 9.69 log10 (E. coli at 10 and 30 s in lab coat surface). In general, E. coli, S. aureus, C. freundii, P. mirabilis, C. albicans and C. parapsilosis showed susceptibility to the biocidal agent under the tested conditions, with >99% reduction after 10 and 30s, while E. faecalis and P. aeruginosa showed a lower susceptibility. The 30s exposure time was more effective for the inactivation of the tested microorganisms. The results show that the spray disinfection technology has the potential for instant decontamination of PPE, which can contribute to an additional barrier for infection control of healthcare workers in the hospital environment.

Cuidados en los servicios de Prótesis frente a la pandemia por covid-19 / Cares in the Prosthetic services toward COVID-19 pandemic

RESUMEN La covid-19 es una enfermedad infecciosa causada por el virus SARS-CoV-2, y es capaz de provocar un cuadro clínico variable. Los individuos que están en contacto estrecho con pacientes positivos de esta enfermedad, tienen un mayor riesgo de infección. Así les sucede a los trabajadores de la salud que atienden directamente a pacientes. Al igual que otros servicios de salud, la atención estomatológica requiere del contacto estrecho entre el profesional y el paciente. El objetivo de este trabajo fue describir las principales recomendaciones para la prevención y control de infecciones por SARS-CoV-2 en los servicios de Prótesis. En la práctica dental, la prevención, el control y la reducción de la transmisión de infecciones se realiza a través del uso del equipo de protección personal y de un conjunto de procedimientos de descontaminación, desinfección y esterilización en cualquier superficie o instrumento. La constante actualización científica y la adopción de medidas de protección antes, durante y después de la atención estomatológica, podrán garantizar el éxito de la atención médica con el mínimo riesgo de contagio (AU).

ABSTRACT COVID-19 is an infectious diseases caused by SARS-CoV-2 virus, and it is able to provoke variable clinical characteristics. The individuals that are in close contact with this disease positive patients are at higher infection risk. That is the case of the heath care workers directly caring for patients. As in any health service, dentistry care requires the narrow contact between the professional and the patient. The aim of this paper was describing the main recommendations for preventing and control SARS-CoV-2 in Prosthetic services. In the dental practice, the prevention, control and reduction of infection transmission is achieved using the personal protection equipment and a whole of decontamination, disinfection and sterilization procedures in any surface or device. The constant scientific updating and adopting protection measures before, during and after the dentistry care can ensure the success of health care with the minimal risk of contagion (AU).

Use of personal protective equipment to care for patients with COVID-19: scoping review.

OBJECTIVE: To summarize the knowledge about recommendations for the use of personal protective equipment necessary for the provision of care by health professionals to patients suspected or infected by the new coronavirus. METHOD: Scoping review with search for primary studies, reviews and preprints articles in English, Portuguese and Spanish, in the last 20 years on the bases WOS/ISI, SCOPUS, MEDLINE/PuBMed, CINAHL, LILACS and SciELO. Unpublished studies in journals were surveyed on bioRxiv and SciELO preprints. RESULTS: 23 studies were eligible. Experiences with coronavirus prior to SARS-CoV-2 revealed that the equipment was an essential barrier in preventing transmission and followed the recommendations for standard precautions, contact, droplet and aerosol. In 13 (57%) studies, this equipment complied international recommendations and in 10 (45%) local recommendations. CONCLUSION: The personal protective equipment used does not follow global standardization according to type, quality and adequate provision, exposing these professionals to the risk of contamination.

Adaptation of the stomatherapy service during the COVID-19 pandemic: an experience report.

OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.

COVID-19 among healthcare workers in a Southern Brazilian Hospital and evaluation of a diagnostic strategy based on the RT-PCR test and retest for Sars-CoV-2.

OBJECTIVE: Healthcare workers are at risk for COVID-19 contamination. It is important to protect them in order to reduce nosocomial transmission and maintain the assistance capacity of health systems. To evaluate the diagnostic test and retest strategy with RT-PCR for SARS-CoV-2 and factors associated with the diagnosis of COVID-19 among healthcare workers. PATIENTS AND METHODS: Cross-sectional study carried out in a Brazilian hospital. From April 27 to June 16, 2020, symptomatic healthcare workers underwent an RT-PCR test on upper respiratory tract specimens as soon as possible and, if negative, it was repeated close to the 5th day of symptom evolution. Working areas were divided into assistance areas dedicated or not dedicated to COVID-19 and non-assistance areas. The type of activity was divided into assistance or non-assistance activity. RESULTS: 775 individuals were evaluated. 114 were diagnosed with COVID-19, of whom 101 followed the testing protocol. A second RT-PCR identified five (4.9%) of the positive cases. Working in an area dedicated to patients with COVID-19 was more prevalent among positive cases (35.1% x 19.8%, p=0.001) as well as working in an assistance activity (80.7% x 70.8%, p=0.031). CONCLUSIONS: A second RT-PCR test after the 5th day of symptom evolution showed limited diagnostic improvement. The adoption of a single test-based strategy, carried out at the right time after the onset of symptoms, allows the optimal use of resources. Working in a COVID-19 dedicated area and in direct contact with patients is related to a higher prevalence of COVID-19 among symptomatic healthcare workers.

Low Incidence and Mortality by SARS-CoV-2 Infection Among Healthcare Workers in a Health National Center in Mexico: Successful Establishment of an Occupational Medicine Program.

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) constitute a population which is significantly affected by SARS-CoV-2 infection worldwide. In Mexico, the Instituto Nacional de Enfermedades Respiratorias (INER) is the principal national reference of respiratory diseases. Aim: To evaluate the efficiency of the INER-POL-TRAB-COVID19 program to mitigate the SARS-CoV-2 infection risk among the INER-healthcare workers (INER-HCW). Methods: Currently, the INER has 250 beds and 200 respiratory ventilators to support COVID-19 patients in critical condition. On March 1st, 2020, the INER-POL-TRAB-COVID19 program was launched to mitigate the SARS-CoV-2 infection risk among the INER-HCW. Findings: From March 1st to October 1st, 2020, 71.5% of INER-HCWs were tested for SARS-CoV-2 infection, and 77% of them were frontline workers. Among the tested INER-HCWs, 10.4% were positive for SARS-CoV-2 infection. Nonetheless, nosocomial infection represented only 3.8% of the cases and the mortality was null. Fifty-three of INER-HCWs positive to SARS-CoV-2 had a negative test 42-56 days post-diagnosis and were returned to service. Finally, although a change in the PPE implemented on May 11th, 2020, the incidence of SARS-CoV-2 infection was not affected. Conclusion: INER has a lower incidence of HCWs infected with SARS-CoV-2 as compared to the mean of the national report. The implementation of the INER-POL-TRAB-COVID19 program is efficient to decrease the risk of infection among the HCWs. Our findings suggest that the implementation of a similar program at a national level can be helpful to provide a safe environment to HCWs and to prevent the collapse of health institutions.

Risk conditions in healthcare workers of a pediatric COVID center in Mexico City / Condiciones de riesgo en el personal de salud de un centro COVID pediátrico de la Ciudad de México

Abstract Background: The new evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by its high capacity to transmit. Health-care personnel is highly susceptible to becoming infected. This study aimed to determine the characteristics and known risk factors for contagion and severe outcomes of SARS-CoV-2 disease in health-care personnel of a pediatric coronavirus disease (COVID) center in Mexico City. Methods: In the last week of March 2020 (at the beginning of phase 2 of the Ministry of Health's national campaign in Mexico), a study was conducted on healthcare workers of a pediatric COVID hospital in Mexico City. Using a virtual interview, we evaluated comorbidities, mobility, areas and functions where they carry out the activities, protection measures, contact history, and vaccination. According to their activities, healthcare workers were classified into the following areas: medical, nursing, other health-care personnel (researchers, nutritionists, rehabilitation, imaging, and laboratory), administrative, and other services. We compared the variables between the groups of healthcare workers with the X2 test. Results: We included 812 participants. The mean age was 41 ± 11 years, and 33% were overweight or obese, 18% were over 60 years old, and 19% had high blood pressure. Medical and nursing personnel presented a higher proportion in the use of standard protection measures. Conclusions: Among healthcare workers, there are risk conditions for the development of complications in case of SARS-CoV-2 infection. Most medical and nursing personnel use standard protective measures.

Resumen Introducción: La pandemia por el nuevo coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) se caracteriza por su alta capacidad de transmitirse, por lo que el personal de salud es muy susceptible de contagiarse. El objetivo de este estudio fue determinar las características y los factores de riesgo conocidos para el contagio y los desenlaces graves de la enfermedad por SARS-CoV-2 en personal de salud de un centro COVID pediátrico de la Ciudad de México. Método: La última semana de marzo de 2020 (al inicio de la fase 2 de la campaña nacional por coronavirus en México) se realizó un estudio en los trabajadores de la salud de un hospital COVID pediátrico de la Ciudad de México. Mediante una entrevista virtual se evaluaron comorbilidad, movilidad, área y funciones donde se desempeñan las actividades laborales, medidas de protección, antecedentes de contactos y vacunación. Los participantes fueron clasificados en las siguientes áreas: personal médico, enfermería, otro personal de salud (investigadores, nutriólogos, rehabilitación, imagenología, laboratorio), administrativo y otros servicios. Se realizaron comparaciones de las variables con prueba de X2 entre los grupos de trabajadores de la salud Resultados: Se incluyeron 812 participantes. El 33% presentó sobrepeso u obesidad, el 18% eran mayores de 60 años y el 19% tenía hipertensión arterial. El personal médico y de enfermería mostró una mayor proporción de uso de medidas de protección estándar. Conclusiones: Existen condiciones de riesgo para el desarrollo de complicaciones en los trabajadores de la salud en caso de contagio con SARS-CoV-2. La mayoría del personal médico y de enfermería utiliza las medidas de protección estándar.