Projecting COVID-19 isolation bed requirements for people experiencing homelessness.

As COVID-19 spreads across the United States, people experiencing homelessness (PEH) are among the most vulnerable to the virus. To mitigate transmission, municipal governments are procuring isolation facilities for PEH to utilize following possible exposure to the virus. Here we describe the framework for anticipating isolation bed demand in PEH communities that we developed to support public health planning in Austin, Texas during March 2020. Using a mathematical model of COVID-19 transmission, we projected that, under no social distancing orders, a maximum of 299 (95% Confidence Interval: 223, 321) PEH may require isolation rooms in the same week. Based on these analyses, Austin Public Health finalized a lease agreement for 205 isolation rooms on March 27th 2020. As of October 7th 2020, a maximum of 130 rooms have been used on a single day, and a total of 602 PEH have used the facility. As a general rule of thumb, we expect the peak proportion of the PEH population that will require isolation to be roughly triple the projected peak daily incidence in the city. This framework can guide the provisioning of COVID-19 isolation and post-acute care facilities for high risk communities throughout the United States.

Planning and Design of a Full-Outer-Air-Intake Natural Air-Conditioning System for Medical Negative Pressure Isolation Wards.

In the beginning of 2020, the coronavirus (COVID-19) pandemic started to spread globally, causing panic to the lives of people around the world; many countries executed lockdown of cities or even total lockdown of the entire countries. The coronavirus disease (COVID-19) is transmitted via air droplets. In medical environments that use traditional hermetic ventilation systems, medical personnel who come in contact with patients are more susceptible to infection compared to regular staff; therefore, the air flow and air quality of hermetic negative pressure isolation wards are highly critical. For this purpose, the study proposes a full-outer-air-intake natural air-conditioning system for negative pressure isolation wards. This innovative system draws in large amounts of fresh external air to greatly improve the air exchange rate in wards; negative pressure environments can be implemented depending on requirements to solve the issue of nosocomial infections in traditional negative pressure isolation wards that draw air from within the hospital. This greatly reduces the probability of nosocomial infection and infection via air droplets; furthermore, the system's intake and exhaust paths are completely isolated, solving the issue of air cross-contamination. Based on the results from the experiment site, this innovative system was designed and implemented based on the guidelines of hospital facilities and achieved air exchange per hour in excess of 12 times/hour, reaching a maximum of 54.5 times/hour. Indoor CO2 concentration was 576 ppm, negative pressure was -14 Pa, indoor temperature was 23.3°C, indoor humidity was 54.1%, and sensible heat exchange efficiency (ηs) was 105.88% which effectively reduced ventilation load. Therefore, this innovative full-outer-air-intake natural air-conditioning system can provide medical staff and patients with a safe and healthy environment that prevents cross-infection.

Effectiveness of negative pressure isolation stretcher and rooms for SARS-CoV-2 nosocomial infection control and maintenance of South Korean emergency department capacity.

OBJECTIVE: There are growing concerns regarding the lack of COVID-19 pandemic response capacity in already overwhelmed emergency departments (EDs), and lack of proper isolation facilities. This study evaluated the effectiveness of the negative pressure isolation stretcher (NPIS) and additional negative pressure isolation rooms (NPIRs) on the maintenance of emergency care capacity during the COVID-19 outbreak. METHODS: A before and after intervention study was performed between February 27, 2020 and March 31, 2020 at the ED of Chungbuk National University Hospital, Cheongju, South Korea. A total of 2455 patients who visited the ED during the study period were included. Interventions included the introduction of the NPIS and additional NPIRs in the ED. The main outcome of the study was frequency of medical cessation. Secondary outcomes were the average number of ED visits and lengths of stay. RESULTS: After the intervention, average frequency of medical cessation was significantly decreased from 1.6 times per day (range 0-4) in the pre-intervention period to 0.6 times per day (range 0-3) in the post-intervention period (p-value <0.01). On the other hand, the number of patients visiting the ED increased significantly from 67.2 persons per day (range 58-79) pre-intervention to 76.3 persons per day (range 61-88) post-intervention (p value <0.01). However, there were no statistically significant differences in the average ED length of stay across the study phases (p value = 0.50). CONCLUSIONS: This intervention may provide an effective way to prepare and meet the ED response needs of the COVID-19 pandemic.

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis.

Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fifty-two articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.

Quais são os cuidados específicos com grávidas e recém-nascidos? [libras]

"COVID - 19: Perguntas e respostas" é resultado de uma parceria entre o Laboratório Aberto de Interatividade para a Disseminação do Conhecimento Científico e Tecnológico (LAbI), o Laboratório de Tradução Audiovisual da Língua de Sinais (LATRAVILIS) e o projeto InformaSUS, todos vinculados à Universidade Federal de São Carlos (UFSCar).

Disposable Isolation Device to Reduce COVID-19 Contamination During CT Scanning.

RATIONALE AND OBJECTIVES: The use of chest computed tomography (CT) in the era of the COVID-19 pandemic raises concern regarding the transmission risks to patients and staff caused by CT room contamination. Meanwhile the Center for Disease Control guidance for air exchange in between patients may heavily impact workflows. To design a portable custom isolation device to reduce imaging equipment contamination during a pandemic. MATERIALS AND METHODS: Center for Disease Control air exchange guidelines and requirements were reviewed. Device functional requirements were outlined and designed. Engineering requirements were reviewed. Methods of practice and risk mitigation plans were outlined including donning and doffing procedures and failure modes. Cost impact was assessed in terms of CT patient throughput. RESULTS: CT air exchange solutions and alternatives were reviewed. Multiple isolation bag device designs were considered. Several designs were custom fabricated, prototyped and reduced to practice. A final design was tested on volunteers for comfort, test-fit, air seal, and breathability. Less than 14 times enhanced patient throughput was estimated, in an ideal setting, which could more than counterbalance the cost of the device itself. CONCLUSION: A novel isolation bag device is feasible for use in CT and might facilitate containment and reduce contamination in radiology departments during the COVID Pandemic.

Recomendações técnicas para a configuração de uma área de triagem de pacientes com sintomas respiratórios. Documento preliminar 2.3 (5 de abril de 2020) / Recomendaciones técnicas para configuración de una zona de triaje de pacientes con síntomas respiratorios / Technical recommendations for setting up a screening area for patients with respiratory symptoms. Preliminary document 2.3 (April 5, 2020)

A área de triagem possibilita uma avaliação clínica rápida dos pacientes com sintomas respiratórios, para detectar casos que preencham os critérios para internação ou encaminhamento para outro nível de atenção. Principais características: A área de triagem de pacientes com sintomas respiratórios fica localizada em uma unidade de saúde, ou próxima a uma unidade de saúde, e seu objetivo é garantir: (i) a identificação precoce de pacientes com sinais e sintomas de doença respiratória aguda grave; (ii) o isolamento da possível fonte, com a implantação de medidas de controle e prevenção de infecções; e (iii) redução do risco de transmissão hospitalar do agente infeccioso. A área de triagem pode ser instalada em estruturas móveis (tendas, contêineres) ou em estruturas dentro da unidade de saúde designadas e reorganizadas para este fim. As equipes de saúde de emergência podem utilizar as áreas de triagem em colaboração com as unidades de saúde. Essa área de triagem deve funcionar 24 horas por dia, sete dias por semana, e deve ter capacidade de expansão suficiente para atender a demanda por seus serviços. Considerações especiais: A triagem de pacientes com sintomas respiratórios é organizada de acordo com as necessidades e o contexto da unidade de saúde, considerando as ações necessárias para prevenir a transmissão da doença entre pacientes, familiares e profissionais da saúde. Um sistema de encaminhamento deve ser implantado para garantir que os pacientes sejam imediatamente encaminhados ao destino apropriado (internação hospitalar, tratamento ambulatorial, transferência ou domicílio), minimizando o risco de transmissão.

El área de detección permite una evaluación clínica rápida de pacientes con síntomas respiratorios, para detectar casos que cumplen con los criterios de hospitalización o derivación a otro nivel de atención. Características principales: El área de detección para pacientes con síntomas respiratorios se encuentra en una unidad de salud, o cerca de una unidad de salud, y su objetivo es asegurar: (i) la identificación temprana de pacientes con signos y síntomas de enfermedad respiratoria aguda serio (ii) el aislamiento de la posible fuente, con la implementación de medidas de prevención y control de infecciones; y (iii) reducir el riesgo de transmisión hospitalaria del agente infeccioso. El área de detección puede instalarse en estructuras móviles (carpas, contenedores) o en estructuras dentro de la unidad de salud designada y reorganizada para este propósito. Los equipos de salud de emergencia pueden usar las áreas de detección en colaboración con las unidades de salud. Esta área de clasificación debe operar las 24 horas del día, los siete días de la semana, y debe tener suficiente capacidad de expansión para satisfacer la demanda de sus servicios. Consideraciones especiales: la detección de pacientes con síntomas respiratorios se organiza de acuerdo con las necesidades y el contexto de la unidad de salud, considerando las acciones necesarias para prevenir la transmisión de la enfermedad entre pacientes, familiares y profesionales de la salud. Se debe establecer un sistema de derivación para garantizar que los pacientes sean remitidos de inmediato al destino apropiado (ingreso hospitalario, tratamiento ambulatorio, traslado u hogar), minimizando el riesgo de transmisión.

Plano de contingência do município de Aurora do Tocantins do Novo Coronavírus (covid-19) / Contingency plan for the municipality of Aurora do Tocantins for the New Coronavirus (covid-19)

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Aurora no Tocantins. Apresenta quais as definições de casos de infecção humana pelo COVID-19. Orientações de como notificar ao Centro de Informações Estratégicas de Vigilância em Saúde (CIEVS). Quais os períodos de incubação da doença. Fatores sobre a transmissão e tratamento. Investigação epidemiológica. Quais atribuições da Vigilância em Saúde. Orientações para a coleta de amostras no Laboratório Central de Saúde Pública do Tocantins (LACEN-TO) bem como a técnica de coleta de Swabde nasofaringe e orofaringe (swabs combinados), o acondicionamento, transporte e envio das amostras. Traz as recomendações para a coleta de amostras em situação de óbito. Mostra as medidas de prevenção e controle Precauções padrão, as medidas de isolamento. Transporte do paciente. Como se dá a Limpeza e desinfecção de superfícies.

He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Aurora in Tocantins. It presents the definitions of cases of human infection by COVID-19. Guidelines on how to notify the Health Surveillance Strategic Information Center (CIEVS). What are the disease incubation periods. Factors about transmission and treatment. Epidemiological investigation. Which attributions of Health Surveillance. Guidelines for the collection of samples at the Central Laboratory of Public Health of Tocantins (LACEN-TO) as well as the technique of collecting Swabde nasopharynx and oropharynx (combined swabs), packaging, transport and sending of samples . It provides recommendations for the collection of samples in situations of death. Shows prevention and control measures Standard precautions, isolation measures. Transporting the patient. How to clean and disinfect surfaces.

Orienta en la campaña de acciones de combate al Coronavirus (Covid-19) en el municipio de Aurora en Tocantins. Presenta las definiciones de casos de infección humana por COVID-19. Directrices sobre cómo notificar al Centro de Información Estratégica de Vigilancia Sanitaria (CIEVS). Cuáles son los períodos de incubación de la enfermedad. Factores de transmisión y tratamiento. Investigación epidemiológica. Qué atribuciones de la Vigilancia Sanitaria. Lineamientos para la recolección de muestras en el Laboratorio Central de Salud Pública de Tocantins (LACEN-TO) así como la técnica de recolección de Swabde nasofaringe y orofaringe (hisopos combinados), el empaque, transporte y envío de las muestras . Proporciona recomendaciones para la recolección de muestras en situaciones de muerte. Muestra medidas de prevención y control Precauciones estándar, medidas de aislamiento. Transporte del paciente. Cómo limpiar y desinfectar superficies.

Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la commune d'Aurora à Tocantins. Il présente les définitions des cas d'infection humaine par COVID-19. Lignes directrices sur la manière de notifier le Centre d'information stratégique de surveillance sanitaire (CIEVS). Quelles sont les périodes d'incubation de la maladie. Facteurs de transmission et de traitement. Enquête épidémiologique. Quelles attributions de Surveillance de la Santé. Directives pour le prélèvement d'échantillons au Laboratoire Central de Santé Publique de Tocantins (LACEN-TO) ainsi que la technique de prélèvement Swabde rhinopharynx et oropharynx (écouvillons combinés), emballage, transport et envoi des échantillons . Il fournit des recommandations pour le prélèvement d'échantillons en cas de décès. Affiche les mesures de prévention et de contrôle Précautions standard, mesures d'isolement. Transport du patient. Comment nettoyer et désinfecter les surfaces.

Instructivo: lista de verificación de alistamiento para la respuesta al COVID-19 en hospitales / Instructions: enlistment checklist for the response to COVID-19 in hospitals

La capacidad de respuesta de un hospital puede ser superada por la llegada masiva de pacientes que soliciten atención médica como consecuencia de una situación de emergencia. Ante este escenario, se debe considerar si el establecimiento de salud está organizado para garantizar la gestión integral de la respuesta hospitalaria, el funcionamiento de los mecanismos de coordinación, el manejo integral de la información, las capacidades logísticas para facilitar la respuesta, y los recursos necesarios para su ejecución, así como para una respuesta integral a los pacientes, precautelando la salud y bienestar de los trabajadores de salud. En este contexto, se insta a los hospitales a implementar las acciones que han desarrollado en su fase de preparativos ante emergencias originadas por amenazas biológicas, específicamente las que pueden provocar enfermedad respiratoria aguda grave, para la identificación de casos sospechosos, limitación de la transmisión al interior del establecimiento y otorgar atención médica especializada. Esto incluye la activación de protocolos y procedimientos en espacios físicos seguros, con énfasis en las medidas de aislamiento, capacitación y entrenamiento de su personal en el uso de equipo de protección personal (EPP), manejo de pacientes, toma y manejo de muestras, así como manejo y disposición de residuos biológicos peligrosos.

Lista de verificación de alistamiento para la respuesta al 2019-nCoV en hospitales / Enlistment checklist for response to 2019-nCoV in hospitals

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Evacuación aeromédica de pacientes COVID-19. Reporte de casos / Case reports: Aeromedical evacuation of patients COVID-19

BACKGROUND: The aeromedical evacuation in the Chilean Air Force has had an important development in the last 15 years. The coronavirus disease declared as a global pandemic by the WHO has generated the challenge of transferring highly infectious patients to centers of greater complexity. The objective of this article is to report our experience in the transfer of COVID ­ 19 patients in constant attention and medical monitoring. CLINICAL CASE REPORTS: The aeromedical evacuation of 2 COVID-19 patients was performed from the Hanga Roa Hospital, Rapa Nui, to the National Thorax Institute, Metropolitan Region, in a Lockheed Hercules C-130, which corresponds to a pressurized fixed-wing airplane. The transfer was carried out with the corresponding personal protection elements and in individual isolation capsules with advanced negative pressure life support (ISO ­ POD), in order to reduce the level of contagion to the aero sanitary crew and minimize the impact on the flight material used. DISCUSSION: The transfer was carried out achieving all the objectives set out under a strict security protocol and the two COVID-19 patients were transferred successfully. The negative pressure isolation capsule system was safe and reliable, since no crew member presented symptoms or was infected by COVID -19, and also allowed the transfer of highly contagious patients during an 8-hour flight operation.

INTRODUCCIÓN: La evacuación aeromédica en la Fuerza Aérea de Chile ha tenido un importante desarrollo en los últimos 15 años. La enfermedad por coronavirus declarada como pandemia mundial por la OMS ha generado el desafío de trasladar pacientes altamente infecciosos a centros de mayor complejidad. El objetivo de este artículo es reportar nuestra experiencia en el traslado de pacientes COVID ­ 19 en constante atención y monitorización médica. REPORTE DE CASOS CLÍNICOS: Se realizó la evacuación aeromédica de 2 pacientes COVID ­ 19 desde el Hospital de Hanga Roa, Rapa Nui, hacía el Instituto Nacional del Tórax, Región Metropolitana, en un Lockheed Hércules C-130, que corresponde a un avión de ala fija presurizado. El traslado se realizó con los elementos de protección personal correspondientes y en capsulas de aislamiento individual con soporte vital avanzado a presión negativa (ISO ­ POD), con la finalidad de reducir el nivel de contagio a la tripulación aero sanitaria y minimizar el impacto en el material de vuelo utilizado. DISCUSIÓN: El traslado se desarrolló logrando todos los objetivos planteados bajo un estricto protocolo de seguridad y los dos enfermos COVID-19 fueron trasladados de manera exitosa. El sistema de cápsulas de aislamiento a presión negativa fue seguro y confiable, ya que ningún miembro de la tripulación presento sintomatología o resultó contagiado por COVID -19, y además permitió trasladar pacientes altamente contagiosos durante una operación de vuelo de 8 horas.

The effectiveness of antibacterial curtains in comparison with standard privacy curtains against transmission of microorganisms in a hospital setting.

Studies have shown a correlation between a cleaner patient environment and lower infection rates and reduced risk of transmission. Privacy curtains are potentially important sites of bacterial contamination in hospitals. Privacy curtains integrated with antimicrobial properties have been shown to increase the time to first contamination compared with standard privacy curtains. In this study, we examined the difference in bacterial colonization of different curtains. We experimentally contaminated antibacterial Fantex protective curtains and compared the bacterial counts to natural contamination of privacy curtains. There was a significant reduction in the CFU/cm2 on antibacterial Fantex protective privacy curtains after 24 hours of experimental contamination with Pseudomonas aeruginosa, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum-producing organisms (Escherichia coli or Klebsiella pneumoniae), compared to standard privacy curtains. Levels of environmental contamination with S. epidermis, Streptococcus viridians, E. coli, S. haemolyticus, S. aureus, S. capitis, non-fermenting Gram-negative bacteria, and Bacillus species were also significantly less on the Fantex curtains after two months hanging in the emergency department. Healthcare facilities may find that addressing surfaces, including use of antibacterial privacy curtains, is an effective horizontal strategy for addressing healthcare-associated infections across the board.

Music in Seclusion Rooms-Development, Implementation, and Initial Testing of a Music Listening Device.

Although presented as a care measure, the use of seclusion rooms (SR) is controversial for both ethical and therapeutic reasons. Given that music seems to have a positive impact on psychiatric patients, offering them the possibility of listening to music might help to improve the care dimension of SR use. This study aimed to develop, implement, and test a musical listening device that would be completely at patients' disposal, easy to use and beneficial to the quality of care provided in SRs. Over a 12-week period, interviews were conducted with nurses (N = 6) caring for patients placed in an equipped SR. The music player was user friendly, encouraged patients to make choices and decisions, helping them to regain control over themselves and their behavior, and elicited various patient-nurse interactions, thus contributing to the establishment of a caring relation. Further research is warranted to examine whether the systematic use of the music player has an impact on the subjective experience of both patients and caregivers, and on daily ward routine.

Aeromedical Transfer of Patients with Viral Hemorrhagic Fever.

For >40 years, the British Royal Air Force has maintained an aeromedical evacuation facility, the Deployable Air Isolator Team (DAIT), to transport patients with possible or confirmed highly infectious diseases to the United Kingdom. Since 2012, the DAIT, a joint Department of Health and Ministry of Defence asset, has successfully transferred 1 case-patient with Crimean-Congo hemorrhagic fever, 5 case-patients with Ebola virus disease, and 5 case-patients with high-risk Ebola virus exposure. Currently, no UK-published guidelines exist on how to transfer such patients. Here we describe the DAIT procedures from collection at point of illness or exposure to delivery into a dedicated specialist center. We provide illustrations of the challenges faced and, where appropriate, the enhancements made to the process over time.

Transportation capacity for patients with highly infectious diseases in Europe: a survey in 16 nations.

Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. In most European Union member states specialized isolation facilities are responsible for the management of such cases. Ground ambulances are often affiliated with those facilities because rapid relocation of patients is most desirable. To date, no pooled data on the accessibility, technical specifications and operational procedures for such transport capacities are available. During 2009, the 'European Network for HIDs' conducted a cross-sectional analysis of hospitals responsible for HID patients in Europe including an assessment of (a) legal aspects; (b) technical and infrastructure aspects; and (c) operational procedures for ground ambulances used for HID transport. Overall, 48 isolation facilities in 16 European countries were evaluated and feedback rates ranged from 78% to 100% (n = 37 to n = 48 centres). Only 46.8% (22/47) of all centres have both national and local guidelines regulating HID patient transport. If recommended, specific equipment is found in 90% of centres (9/10), but standard ambulances in only 6/13 centres (46%). Exclusive entrances (32/45; 71%) and pathways (30/44; 68.2%) for patient admission, as well as protocols for disinfection of ambulances (34/47; 72.3%) and equipment (30/43; 69.8%) exist in most centres. In conclusion, the availability and technical specifications of ambulances broadly differ, reflecting different preparedness levels within the European Union. Hence, regulations for technical specifications and operational procedures should be harmonized to promote patient and healthcare worker safety.

Isolation unit for multidrug-resistant tuberculosis patients in a low endemic country, a step towards the World Health Organization End TB Strategy.

Tuberculosis (TB) remains a threat to public health and is the second cause of death due to a single infectious agent after HIV/AIDS. The worldwide distribution of TB is heterogeneous. The incidence is decreasing in most high-income regions, but the situation remains worrying in many parts of the world. The emergence of Mycobacterium tuberculosis strains resistant to key agents used in treatment (rifampin and isoniazid) contributes to TB transmission around the world. To achieve TB elimination, both high and low endemic countries must upscale their efforts to decrease disease transmission and improve cure rates. Management of drug-resistant TB is of particular importance. In this paper, we discuss the different models of care of multidrug-resistant TB (MDR-TB), the ethical considerations and the specific constraints present in high income countries. The management model chosen by the Belgian TB specialists in accordance with public health authorities as well as building of a specific MDR/XDR-TB isolation unit are also discussed.

Actuación de enfermería ante un paciente con sospecha de enfermedad del virus del Ébola / The performance of nursing a patient with suspected case of Ebola

El virus del Ébola se detectó por primera vez en 1976 en la República democrática del Congo y en el sur de Sudán. Desde entonces, ha habido varios brotes en África occidental, pero es en 2014 cuando amenazó con convertirse en un problema de salud pública a nivel mundial. Una de las principales causas de este fenómeno es la expansión del virus desde zonas rurales a zonas urbanizadas desorganizadas. La epidemia avanzó de forma imparable a pesar de los esfuerzos de la OMS, Médicos Sin Fronteras y los gobiernos de Sierra Leona, Guinea y Liberia, y alcanzó una cifra de aproximadamente 5000 fallecidos, de los cuales un 5 % eran personal sanitario (noviembre 2014). España fue el primer país con un caso de contagio fuera de África. La infección de una trabajadora sanitaria de un hospital de Madrid hizo cundir el pánico en todo el Estado. Ello obligó a las autoridades sanitarias nacionales e internacionales a revisar y actualizar los protocolos de actuación ante casos de pacientes con sospecha de enfermedad del virus del Ébola. Se presenta un caso clínico en el que se describen los cuidados a un paciente con sospecha de enfermedad por virus del Ébola y las medidas de aislamiento de nivel IV (AU)

Ebola virus was first detected in Congo and south of Sudan in 1976. Since then, there have been several limited spreads in occidental Africa, but it is in 2014 when it became a worldwide public health problem. One of the main causes of this phenomenon was the migration of the virus from rural areas to marginal urban areas. The epidemic advanced despite the efforts of WHO, Medicines Sans Frontiers and the governments of Guinea, Liberia and Sierra Leone to stop it. The number of deaths was around 5000, and 5 % of these were sanitary workers. Spain was the first country with a contagion outside Africa. One sanitary person from a Hospital in Madrid got the virus and resulted in panic all around Spain. This forced the sanitary authorities to revise and actualize protocols when we treat patients under suspicion of Ebola virus infection. We report a case in which we describe the care we provide to a patient with suspected Ebola disease and isolation measures level IV (AU)

A Novel Approach to CT, MR, and PET Examination of Patients with Infections Requiring Stringent Airborne Precautions.

PURPOSE: To investigate the feasibility of using a modified portable isolation chamber, which conforms to Centers for Disease Control and Prevention (CDC) isolation requirements, in the imaging of infectious patients. MATERIALS AND METHODS: This study was approved by the ethics committee, and all participants gave written informed consent. In this prospective study, the isolation chamber was assessed for computed tomographic (CT), magnetic resonance (MR), and positron emission tomographic (PET) image uniformity and noise by using uniform phantoms. For each modality, equivalent phantom examinations were performed without the isolation chamber. Paired analyses of the differences from these baseline values were conducted by finding the mean difference in the matched sections for each image quality parameter. A potential increase in CT patient dose was assessed, and MR radiofrequency (RF) interference was monitored. Eight participants with active pulmonary tuberculosis (mean age, 48.1 years; age range, 26-88 years; five men, three women) were then examined within a hybrid PET/MR imager. The 95% confidence intervals for the difference in the two matched population means were determined by using the two-sided t distribution for each of the phantom study imaging modalities. RESULTS: Phantom images were evaluated for image uniformity and noise. Increased image noise can affect low contrast resolution, which has the potential to mimic or mask abnormalities when the differences between healthy and diseased tissues are small; clinically, CT image noise is maintained at a constant level with dose modulation. Increased attenuation of annihilation photons, when not corrected for, could lead to photopenic areas on the PET image; PET image nonuniformity complied with guidelines. Artifacts on the MR image due to RF noise spikes could mask abnormalities; paired analysis of variations in MR imaging mean signal-to-noise ratio and uniformity from baseline were within 5% for both gradient-echo and spin-echo sequences. In the eight participants who underwent imaging, the increased radiation dose for the attenuation of the isolation chamber would have resulted in a mean increase in patient size-specific dose estimate of 0.32 mGy ± 0.04 (standard deviation). The RF noise assessment revealed no prominent increase at any frequency band. The eight participants were examined within the isolation chamber without incident. CONCLUSION A modified portable isolation chamber, which conforms to CDC infection control guidelines, was found to be feasible within the confines of CT, MR imaging, and PET environments.

Airplane transport isolators may loose leak tightness after rapid cabin decompression.

Air medical transport of patients suffering of highly infectious diseases is typically performed employing portable isolation chambers. Although the likelihood of decompression flight emergencies is low, sustainability of the devices used is crucial. When a standard isolation unit was subjected to an explosive cabin decompression of 493 hPa, simulating a 32808 ft flight level accident, leak tightness of the unit was lost due to rupture of the bag caused by over expansion. When the pressure chamber experiment was repeated with a modified unit, distension was minimized by an additional compensation air bag, thus ensuring leak tightness.