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1.
Emerg Infect Dis ; 27(4): 1229-1231, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33755002

RESUMO

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Fômites/virologia , Controle de Infecções , /isolamento & purificação , Idoso , Número Básico de Reprodução , /prevenção & controle , /virologia , Criança , Creches/normas , Descontaminação/métodos , Contaminação de Equipamentos/prevenção & controle , Desinfecção das Mãos/métodos , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Máscaras , Casas de Saúde/normas , Instituições Acadêmicas/normas , Estados Unidos/epidemiologia
2.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 60-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666913

RESUMO

The threat of shortages of personal protective equipment have led to innovations in protective barriers to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Those performing aerosolizing procedures such as endotracheal intubation have been designated by the Centers for Disease Control as increased risk of contracting COVID-19. Evaluation of aerosolizing containing barriers for intubation has been limited to date. Some have raised concerns about the universal use of these devices and their possible iatrogenic side effects. It is clear that in time periods of atypical practice that quality and outcome review are critical to addressing novel problems as they arise. An unusual set of injury patterns associated with videolaryngoscopy lead to further evaluation and reconsideration of these devices in our own military department. We review the current literature on this topic and provide a perspective from a single large academic military treatment facility.


Assuntos
/prevenção & controle , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Militares , Equipamento de Proteção Individual , Aerossóis , Humanos
3.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 137-143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666927

RESUMO

The historic outbreak of the novel coronavirus (SARS CoV-2) sent concern and even panic around the world due to the unknown nature of this disease. As a result, the US implemented a whole-of government approach to tackle the outbreak of this deadly virus. The national and global impact of an uncontrolled COVID-19 outbreak, threatens the US healthcare system and our way of life with potential to cause riveting economic and national security instability. As a result of the health impact on American society, the US military must also take precaution to preserve and defend our nation's fighting force. This charge has created a unique opportunity for military medicine to take the lead at the front line to combat this biologic viral threat.


Assuntos
/prevenção & controle , Odontologia/organização & administração , Controle de Infecções/instrumentação , Controle de Infecções/organização & administração , Medicina Militar/organização & administração , /epidemiologia , Humanos , Equipamento de Proteção Individual , Guias de Prática Clínica como Assunto , Estados Unidos
4.
Arch Argent Pediatr ; 119(2): 76-82, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33749192

RESUMO

INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.


Assuntos
/prevenção & controle , Recursos em Saúde/provisão & distribução , Cuidado do Lactente/organização & administração , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Argentina/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Política de Saúde , Humanos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Guias de Prática Clínica como Assunto , Gravidez
5.
BMJ Open ; 11(3): e044644, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653758

RESUMO

INTRODUCTION: Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources. METHODS: Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies. RESULTS: In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources. CONCLUSION: These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.


Assuntos
/prevenção & controle , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência à Saúde , Pessoal de Saúde , Humanos , Modelos Teóricos , Pandemias , Equipamento de Proteção Individual
6.
J Plast Reconstr Aesthet Surg ; 74(1): 199-202, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33645504

RESUMO

Coronavirus disease-2019 (COVID-19) is the infectious disease caused by the recently discovered coronavirus, SARS-CoV2. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The number of publications with regard to COVID-19-related information is exponentially increasing, but there are also some retracted papers appearing on PubMed, including those retracted from The Lancet Global Health and the New England Journal of Medicine. In a PubMed search for "COVID," there were 1595 articles by April 1, 2020. As of June 30, the number of articles has now reached 25,913. In this editorial, 4 specific areas of information are looked at but the principles apply to many other areas of medicine. The specifics looked at are PPE for tracheostomy, testing for COVID-19, pregnancy and COVID-19, and surgical expectations during redeployment. We must make no mistake that we are seeing a disease that modern medicine has never encountered before. This article is not aimed at belittling or dismissing any of the advice of the Royal Colleges' or PHE advice, but it demonstrates the tsunami of information and the ambiguity that surgeons are experiencing throughout the UK right now. This is unlikely to be the end of progression regarding healthcare planning and development for unencountered viruses9. In the next few months and beyond, there are likely to be adaptions and revisions of more documents advising on various aspects of healthcare with regard to COVID-19 management and for possible future viruses not yet seen by the modern world before.


Assuntos
Controle de Infecções , Procedimentos Cirúrgicos Reconstrutivos , Centro Cirúrgico Hospitalar , /epidemiologia , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Disseminação de Informação , Inovação Organizacional , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/tendências
7.
J Am Board Fam Med ; 34(Suppl): S26-S28, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33622813

RESUMO

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider. The Medical Expenditure Panel Survey (MEPS) is a representative sample of patients from the United States that regularly assesses their use of medical care services. We analyzed 2017 MEPS data to determine the number and proportion of patients who were seen in primary care or family medicine ambulatory settings or hospitalized for upper or lower respiratory illness or pneumonia. In a given year, 19.5 million patients are seen by primary care for an upper respiratory illness, 10.7 million patients for bronchitis, and 9 million for pneumonia. In contrast, 890,000 patients are hospitalized with pneumonia. Given that a primary etiology for respiratory illness in early 2020 was SARS CoV-2 (COVID-19), primary care practices likely were the site of first contact for most patients with COVID-19 illness. Unfortunately, there has been inadequate support for in-person and telehealth visits. Primary care clinicians reported serious shortages of personal protective equipment (PPE) and testing capacity. Inadequate reimbursement for telehealth visits coupled with decreased in-person visits put primary care practices at risk of layoffs and closure. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Assistência Ambulatorial/organização & administração , Medicina de Família e Comunidade/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Equipamento de Proteção Individual/provisão & distribução , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos
8.
Epidemiol Infect ; 149: e61, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33622421

RESUMO

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.


Assuntos
Febre/terapia , Modelos Organizacionais , Isolamento de Pacientes/métodos , /complicações , China/epidemiologia , Febre/epidemiologia , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Isolamento de Pacientes/tendências
9.
Emerg Infect Dis ; 27(4): 1032-1038, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33591249

RESUMO

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Indústria de Processamento de Alimentos , Controle de Infecções , Indústria de Embalagem de Carne , Adulto , /epidemiologia , /transmissão , Feminino , Indústria de Processamento de Alimentos/métodos , Indústria de Processamento de Alimentos/organização & administração , Indústria de Processamento de Alimentos/tendências , Humanos , Incidência , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Indústria de Embalagem de Carne/métodos , Indústria de Embalagem de Carne/organização & administração , Indústria de Embalagem de Carne/tendências , Saúde das Minorias/estatística & dados numéricos , Nebraska/epidemiologia , Saúde do Trabalhador/normas , Avaliação de Resultados em Cuidados de Saúde , Equipamento de Proteção Individual/normas , Medição de Risco , Local de Trabalho/normas
10.
Saudi Med J ; 42(2): 166-169, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33563735

RESUMO

OBJECTIVES: To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation. METHODS: Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed. RESULTS: Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=-1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted. CONCLUSION: No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.


Assuntos
Amputação , Pé Diabético/cirurgia , Controle de Infecções/métodos , Assistência Perioperatória/métodos , Bósnia e Herzegóvina/epidemiologia , /epidemiologia , Pé Diabético/complicações , Feminino , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pandemias , Equipamento de Proteção Individual , Estudos Prospectivos , Resultado do Tratamento , Cicatrização
12.
J Trauma Acute Care Surg ; 90(4): e72-e80, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33433175

RESUMO

BACKGROUND: Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients. METHODS: We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). RESULTS: Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit. CONCLUSION: The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations. LEVEL OF EVIDENCE: Review, level II.


Assuntos
/prevenção & controle , Pessoal de Saúde , Controle de Infecções , Máscaras , Centro Cirúrgico Hospitalar , Centros de Traumatologia , /epidemiologia , Descontaminação/métodos , Reutilização de Equipamento , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Máscaras/normas , Máscaras/virologia , /virologia , Equipamento de Proteção Individual/classificação , Equipamento de Proteção Individual/normas
13.
Air Med J ; 40(1): 76-78, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33455633

RESUMO

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.


Assuntos
Medicina Aeroespacial/métodos , Resgate Aéreo , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Medicina Militar/métodos , Militares , Medicina Aeroespacial/instrumentação , Medicina Aeroespacial/tendências , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/tendências , Medicina Militar/instrumentação , Medicina Militar/tendências , Estados Unidos
14.
Artigo em Inglês | MEDLINE | ID: mdl-33478170

RESUMO

Relevant personal protective measures during the COVID-19 pandemic include face masks, possibly decreasing the risk of infection among the general population and healthcare workers (HCW) if utilized properly. The aim of the study was to assess whether different Polish HCW utilize face masks according to the 2020 World Health Organization guidance (WHO) criteria. This cross-sectional study included 1156 respondents who participated in an internet survey evaluating mask-related behaviors. All the WHO criteria were complied with by 1.4% of participants, regardless of medical profession, specialty or place of employment. HCW mostly adhered to criterion 1 (C1; strict covering of the face and mouth with the mask; 90.8%), C4 (washing/disinfecting the hands after touching/taking off the mask; 49%) and C3 (taking off the mask properly without touching the anterior surface; 43.4%), whereas C2 (avoidance of touching the mask with hands) was complied with least commonly (6.8%). HCW with mask-induced itch (31.6%) complied to C2 less often (odds ratio 0.53; p = 0.01). The study reveals that Polish HCW rarely adhere to all the 2020 WHO guidance criteria on the use of masks, whereas the adherence to particular criteria is variable and may be associated with the presence of skin-related conditions and other factors. Better compliance with the recommendations in the future is necessary to increase personal safety of HCW and prevent the transmission of SARS-CoV-2.


Assuntos
/prevenção & controle , Pessoal de Saúde , Controle de Infecções/instrumentação , Máscaras/estatística & dados numéricos , Pandemias , Estudos Transversais , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Polônia
15.
Monaldi Arch Chest Dis ; 91(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33501822

RESUMO

COVID 19 pandemic has brought about a sea change in health care practices across the globe. All specialities have changed their way of working during the pandemic. In this study, we evaluated the impact of COVID-19 on the practice of interventional pulmonology at our centre. All interventional pulmonology procedures done during the three months after implementation of lockdown were evaluated retrospectively for patient demographics, clinical diagnosis, indication for procedure and diagnostic accuracy. The changes in practices, additional human resources requirement, the additional cost per procedure and impact on resident training were also assessed. Procedures done during the month of January 2020 were used as controls for comparison. Twenty-two flexible bronchoscopies (75.8%), four semirigid thoracoscopies (13.7%) and three EBUS-TBNAs (10.3%) were carried out during three month lockdown period as compared to 174 during January 2020. Twenty-three of the procedures were for the diagnostic indication (79%), and six were therapeutic (20.6%). The diagnostic yield in suspected neoplasm was 100% while for suspected infections was 58.3%. The percentage of independent procedures being done by residents reduced from 45.4% to 0%. The workforce required per procedure increased from 0.75 to 4-8, and the additional cost per procedure came out to be 135 USD. To conclude, COVID 19 has impacted the interventional pulmonology services in various ways and brought about a need to reorganize the services, while also thinking of innovative ideas to reduce cost without compromising patient safety.


Assuntos
Broncoscopia , Assistência à Saúde , Controle de Infecções , Pneumopatias , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , /prevenção & controle , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
16.
Anesth Analg ; 132(1): 38-45, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315602

RESUMO

BACKGROUND: Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. METHODS: Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator. Aerosols were modeled using a commercially available fog machine, and droplets were modeled with fluorescein dye. Both particles were propelled by the cough simulator in a simulated intubation environment. Data were captured by high-speed flash photography, and aerosol and droplet dispersion were assessed qualitatively with and without a barrier in place. RESULTS: Droplet contamination after a simulated cough was seemingly contained by both barrier devices. Simulated aerosol escaped the barriers and flowed toward the head of the bed. During barrier removal, simulated aerosol trapped underneath was released and propelled toward the HCW at the head of the bed. Usage of the intubation sheet concentrated droplets onto a smaller area. If no barrier was used, positioning the patient in slight reverse Trendelenburg directed aerosols away from the HCW located at the head of the bed. CONCLUSIONS: Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.


Assuntos
/terapia , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição por Inalação/prevenção & controle , Intubação Intratraqueal , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual , Aerossóis , Humanos , Exposição por Inalação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Manequins , Teste de Materiais , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador
17.
Semergen ; 47(2): 122-130, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-33358090

RESUMO

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Assuntos
/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/ética , Acesso aos Serviços de Saúde/ética , Controle de Infecções/métodos , Atenção Primária à Saúde/ética , Telemedicina/ética , /epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/ética , Serviços de Saúde para Idosos/organização & administração , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/organização & administração , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/organização & administração , Espanha/epidemiologia , Telemedicina/métodos , Telemedicina/organização & administração
19.
Cornea ; 40(1): 121-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32355114

RESUMO

PURPOSE: To report the germicidal range ultraviolet (UV) irradiation-induced phototoxicity because of unprotected exposure to the UV lamps for presumed household disinfection of SARS-CoV-2 in a domestic setting. METHODS: We report on a family of 3 adults who experienced photophobia, intense eye pain, epiphora, blurred vision, and a burning sensation over the face and neck area after a short period of unprotected exposure to the UV germicidal lamps. RESULTS: An initial examination revealed erythema and tenderness over the face and neck area, reduced visual acuity of 6/12, and conjunctival injections bilaterally in all 3 patients. Further assessment at the ophthalmology department 3 days later revealed gradual improvement of visual acuity to 6/6 bilaterally. Slit-lamp examinations revealed few punctate epithelial erosions. Fundal examinations were normal without evidence of solar retinopathy. The patients were diagnosed with germicidal range UV irradiation-induced photokeratitis and epidermal phototoxicity. Lubricants and emollients were prescribed for symptom relief, and the patients were warned against using a UV germicidal lamp for disinfection purposes without appropriate protection. CONCLUSIONS: Although SARS-CoV-2 is structurally akin to SARS-CoV-1 and MERS-CoV, and previous studies demonstrated high levels of inactivation of beta-coronavirus with germicidal-range UV, evidence for its efficacy to inactivate SARS-CoV-2 is lacking. This case report serves to emphasize the potential consequences of phototoxicity from the improper use of UV germicidal lamps for household disinfection and to highlight the fact that UV germicidal lamps currently have no established role in household disinfection of SARS-CoV-2.


Assuntos
/prevenção & controle , Dermatite Fototóxica/etiologia , Desinfecção/instrumentação , Fotofobia/etiologia , Lesões por Radiação/etiologia , Raios Ultravioleta/efeitos adversos , Adolescente , Dermatite Fototóxica/diagnóstico , Dor Ocular/diagnóstico , Dor Ocular/etiologia , Feminino , Humanos , Controle de Infecções/instrumentação , Fotofobia/diagnóstico , Lesões por Radiação/diagnóstico , Inativação de Vírus/efeitos da radiação
20.
Sensors (Basel) ; 20(24)2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33322315

RESUMO

This paper proposes and demonstrates the capabilities of a new sensorization system that monitors skin contact between two persons. Based on the intrabody communication standard (802.15.6), the new system allows for interbody communication, through the transmission of messages between different persons through the skin when they are touching. The system not only detects if there has been contact between two persons but, as a novelty, is also able to identify the elements that have been in contact. This sensor will be applied to analyze and monitor good follow-up of hand hygiene practice in health care, following the "World Health Organization Guidelines on Hand Hygiene in Health Care". This guide proposes specific recommendations to improve hygiene practices and reduce the transmission of pathogenic microorganisms between patients and health-care workers (HCW). The transmission of nosocomial infections due to improper hand hygiene could be reduced with the aid of a monitoring system that would prevent HCWs from violating the protocol. The cutting-edge sensor proposed in this paper is a crucial innovation for the development of this automated hand hygiene monitoring system (AHHMS).


Assuntos
Higiene das Mãos/instrumentação , Controle de Infecções/instrumentação , Internet das Coisas , Telemedicina , Tato , Comunicação , Humanos , Reprodutibilidade dos Testes
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