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2.
s.l; IETSI; 4 mayo 2020. ilus, tab.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1096646

RESUMO

GENERALIDADES: Existen dos tipos principales de dispositivos usados para prevenir la inhalación de partículas infecciosas en los ambientes hospitalarios: las mascarillas quirúrgicas (llamadas también mascarillas médicas) y los respiradores. Ambos dispositivos de protección difieren por el tipo de ajuste y el tamaño de las partículas que son capaces de filtrar. La mascarilla quirúrgica es un dispositivo de protección personal que cubre la boca, nariz y mentón, aunque su diseño no permite un ajuste preciso a la cara. La mascarilla quirúrgica constituye una barrera que limita el pasaje de un agente infeccioso entre el personal de salud y el paciente. Específicamente, las mascarillas quirúrgicas son usadas para impedir la transmisión de las bacterias y los virus respiratorios que se diseminan por gotas, las cuales viajan distancias cortas y son transferidas por la tos y estornudos. Las utilizan tanto el personal de salud como los pacientes. En el primero, previenen que le lleguen grandes gotas respiratorias o salpicaduras a la boca o nariz del profesional de salud, y en el segundo caso, en los pacientes, estas mascarillas ayudan a reducir o controlar la propagación de grandes gotas respiratorias que el usuario produce ("CDC - Use of Respirators and Surgical Masks for Protection Against Healthcare Hazards - HSPS - NIOSH Workplace Safety and Health Topic" 2018). MÉTODOS: Se llevó a cabo una búsqueda sistemática rápida de la literatura con respecto a la eficacia de las mascarillas quirúrgicas en comparacion con los respiradores para prevenir la infeccion por COVID-19 en el personal de la salud. Para ello se ingresó a las principales bases de datos (PubMed, EMBASE, Scopus, Web of Science, Cochrane). Asimismo, debido a que el COVID-19 es una enfermedad de reciente aparición y la generación nueva evidencia sucede en tiempo real, se revisó en la base de datos de medRxiv, para identificar artículos científicos que estuviesen en proceso de publicación. Adicionalmente, se revisó la plataforma web ClinicalTrials.Gov para identificar estudios en curso. Finalmente, se realizó una búsqueda de reportes, comunicaciones y noticias en las páginas de Google y Twitter. RESULTADOS: Se identificó una revision sistemática (RS) con meta-análisis (MA), un reporte de caso y cuatro guías que correspondieron al objetivo del presente reporte breve. CONCLUSIONES: La evidencia presentada en el presente reporte breve sugiere en general que las mascarillas quirúrgicas o médicas no son inferiores a los respiradores (N95, FFP2 o certificaciones equivalentes) para proteger al personal de salud contra diferentes infecciones respiratorias virales durante la atención sanitaria de rutina donde no se realizan procedimientos que generan aerosoles. La evidencia es indirecta en su mayor parte puesto que se refiere a varios tipos de virus, aunque sí incluyen varios tipos de coronavirus pero no el SARS-Cov-2. Sin embargo, la escasa evidencia directa para el SARS-Cov-2, aunque de bajo rigor metodológico, muestra resultados consistentes con los de la evidencia indirecta, con lo que se apoya la no inferioridad de las mascarillas quirúrgicas en comparación con los respiradores en prevenir infección. Futuros estudios con metodología robusta permitirán tener evidencia de mayor calidad específicamente para SARS-Cov-2.


Assuntos
Dispositivos de Proteção Respiratória/normas , Ventiladores Mecânicos/normas , Infecções por Coronavirus/prevenção & controle , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
3.
s.l; IETSI; 11 mayo 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1096648

RESUMO

INTRODUCCIÓN: El COVID-19 es una enfermedad nueva causada por el virus SARS-CoV-2. Hasta la fecha, la evidencia indica que las principales vías de transmisión del COVID-19 son: 1) de persona a persona a través de gotas respiratorias entre 5 a 10 micrómetros de diámetro (transmisión directa) que son expulsados por una persona infectada al toser o estornudar, las cuales pueden entrar por la boca, nariz, ojos y posiblemente a través de la inhalación en personas que se encuentran a menos de dos metros de distancia; 2) por contacto de superficies contaminadas (transmisión indirecta) por una persona infectada (OMS 2020; CDC 2020a). A la fecha, se describe también la transmisión por la vía área del SARS-CoV-2, la cual ocurre a través de aerosoles, los cuales contienen núcleos de gotas de menos de 5 micrómetros de diámetro. La transmisión a través de aerosoles es particularmente relevante durante los procedimientos generadores de aerosoles (PGA)1. De esta manera, al realizar un PGA, los aerosoles pueden permanecer suspendidos en el aire por un período prolongado de tiempo y desplazarse a más de un metro de distancia (OMS 2020; CDC 2020a). Este tipo de transmisión del SARS-CoV-2 por vía aérea en un contexto diferente al que ocurre durante los PGA es aún incierto y solo ha sido observado en simulaciones que no reflejan condiciones clínicas reales (OMS 2020). Por ello, al momento, la transmisión aérea del SARS-CoV-2 solo cobra relevancia dentro de contextos hospitalarios donde se realizan los PGA. MÉTODOS: Se realizó una búsqueda manual de guías de práctica clínica cuyo objetivo fuese la prevención y control del manejo de la COVID-19 en trabajadores de salud a través de protección respiratoria realizadas por entidades de salud internacionales y gobiernos alrededor del mundo, tales como la organización Mundial de la Salud (OMS, WHO por sus siglas en inglés), los centros para el Control y la Prevención de Enfermedades (CDC por sus siglas en inglés) y guías oficiales utilizadas en otros países como Canadá, Reino Unido y Australia. Además, se llevó a cabo una búsqueda bibliográfica sistemática rápida de la literatura con respecto al uso de los respiradores elastoméricos para protección contra la COVID-19. Para ello se ingresó a las principales bases de datos, a través de los motores de búsqueda de PubMed, Cochrane Library y Google Scholar. Asimismo, se amplió la búsqueda de manera manual revisando el listado de referencias bibliográficas de guías o estudios previamente identificados. Por último, debido a que la COVID-19 es una enfermedad de reciente aparición y la generación de nueva evidencia sucede en tiempo real, se revisó en la base de datos de medRxiv para identificar artículos científicos que estuviesen en proceso de publicación. RESULTADOS: Guías de práctica clínica (GPC. Otros documentos con respecto al uso de los respiradores elastoméricos en el contexto COVID-19. CONCLUSIÓN: Ante la escasez global de dispositivos de protección respiratoria, entidades de salud internacionales (por ejemplo, OMS, CDC) recomiendan que el uso de respiradores convencionales (N95, FPP2, FPP3, o equivalentes) se reserve para el personal de salud expuesto a los procedimientos generadores de aerosoles (PGA), los cuales representan alto riesgo de transmisión aérea del SARS-Cov-2. Cuando la escasez de este tipo de respiradores convencionales es crítica, varias agencias internacionales han aceptado el uso de respiradores elastoméricos de media cara (REMC), recomendando que su uso se restrinja a las mismas situaciones clínicas donde se indican los respiradores convencionales. De hecho, la información expuesta en el presente reporte sugiere que los REMC son de equivalente o superior nivel de eficacia que los respiradores convencionales para proteger al personal de salud que lo usa en el contexto de PGA en pacientes COVID-19. Es menester tener en cuenta que los REMC tienen una válvula inhalatoria con filtro que protege al usuario (personal de salud) de la infección por el SARS-Cov-2; y tiene una válvula exhalatoria sin filtro, lo que representa un potencial riesgo de contagio para las personas, o riesgo de contaminación de las superficies, que se encuentran alrededor, en caso el usuario del REMC esté infectado. Por ello, se recomienda que la implementación de los REMC debe realizarse con una adecuada educación y entrenamiento del personal de salud, así como también con un adecuado protocolo de limpieza, desinfección y almacenamiento para evitar el riesgo de contaminación. Asimismo, se recomienda que el uso de REMC debe restringirse al personal de salud involucrado en áreas hospitalarias donde se realicen PGA de pacientes confirmados de COVID-19 y donde los otros profesionales de salud presentes estén debidamente protegidos con EPP. Si se toma en cuenta estos aspectos, el REMC representa una alternativa razonable en el contexto de escasez crítica de respiradores convencionales.


Assuntos
Humanos , Dispositivos de Proteção Respiratória , Ventiladores Mecânicos , Infecções por Coronavirus/terapia , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
4.
Cochrane Database Syst Rev ; 5: CD011621, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32412096

RESUMO

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


Assuntos
Infecções por Coronavirus , Doença pelo Vírus Ebola , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Betacoronavirus , Líquidos Corporais , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Luvas Protetoras , Pessoal de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Humanos , Controle de Infecções/métodos , Razão de Chances , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Roupa de Proteção , Dispositivos de Proteção Respiratória , Síndrome Respiratória Aguda Grave/prevenção & controle , Síndrome Respiratória Aguda Grave/transmissão
6.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32236089

RESUMO

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Controle de Infecções/métodos , Ventilação não Invasiva/métodos , Modalidades de Fisioterapia , Pneumonia Viral/etiologia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Terapia Respiratória/métodos , Infecções por Coronavirus/reabilitação , Cuidados Críticos , Dispneia/etiologia , Humanos , Hipóxia/complicações , Hipóxia/etiologia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Itália , Ventilação não Invasiva/normas , Pandemias , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Pronação , Respiração Artificial/normas , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/reabilitação , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/reabilitação , Dispositivos de Proteção Respiratória , Terapia Respiratória/normas
7.
s.l; IETSI; abr. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1096585

RESUMO

INTRODUCCIÓN: Existe una pandemia actual causada por un Coronavirus similar a previos virus epidémicos como los coronavirus respiratorios del Síndrome Respiratorio Agudo Severo (SARS-CoV) y del Coronavirus del Síndrome Respiratorio del Medio Oriente (MERS-CoV). Esto llevo a que la OMS declarara una emergencia de salud pública internacional y luego a una situación de pandemia. Como parte de la respuesta global a esta pandemia, varias organización como el Centro para el Control y Prevención de enfermedades de los Estados Unidos (CDC) han elaborado guias sobre como controlar esta enfermedad en entornos sanitarios. Para esto se basan en la experiencia adquirida con la epidemia tanto de los coronovarius SARS como de MERS. Los pacientes infectados parecen ser preferentemente mayores de 15 años, habiendo muy pocos infectados en niños en un análisis hecho de pacientes en China (solo 0.9% de los casos). La mayoría fueron hombres (58.1%). La mediana del periodo de incubación fue 7 días (rango intercuartil de 2 a 7). Los síntomas más comunes son fiebre (88,7%), y tos (67.8%). Aproximadamente 5% de los pacientes requieren unidades de cuidados intensivos (UCIs), y 1.4% murieron, siendo esta edad dependiente. Se sabe que el coronavirus SARS-1puede ser transmitido eficientemente en entornos sanitarios si los pacientes con este virus no son reconocidos inmediatamente, y las medidas de control no son aplicadas. Las medidas básicas de control son efectivas en prevenir la transmisión de SARS1 en entornos sanitarios. Dentro de las actividades prioritarias esta reforzar las prácticas de control de infecciones entre el personal de salud, desarrollar planes para tomar las precauciones necesarias en facilidades hospitalarias, y la detección temprana y aislamiento de los pacientes que podrían estar infectados con el coronavirus. En tal sentido, el objetivo de esta revisión rápida es generar evidencia a partir de la guias de control de infecciones publicada que evalúe los mecanismos de la transmisión de agentes infecciosos respiratorios en entornos sanitarios, y las medidas de precaucione neesarias, con énfasis en el aislamiento de los pacientes. MÉTODOS: Se realizó una revisión narrativa de las principales guías de control de infecciones relacionadas al Coronavirus SARS-1 (SARS-Cov-1) y al Coronavirus SARS-2 (SARS-Cov-2). Estas incluyeron principalmente los documentos del Centro para el Control y Prevención de enfermedades de los Estados Unidos (CDC) sobre aislamiento (7,8). Asimismo para la sección de estándares para las salas de aislamiento se revisaron los documentos pertinentes incluyendo la guías para diseño y construcción de hospitales del Facility Guidelines Institute de los Estados Unidos, que es la guía usada por el gobierno federal y gobiernos estatales de los Estados Unidos, asi como el Texto de Control de Infecciones y Epidemiologia de la Asociacion de profesionales en Control de Infecciones. Ademas esta revision esta suplementada con la ultima información sobre las características de trasnmision estudiadas en el nuevo SARS-Cov-2, como la publicada recientemente en el new England Journal of Medicine. RESULTADOS: Las opciones de hospitalización incluyen habitaciones individuales, habitaciones dobles, y habitaciones de camas múltiples. De estas, las habitaciones individuales siempre están indicadas para pacientes en Precauciones de Transmisión aérea, y son las habitaciones preferidas para Precauciones de Gotas aéreas, aunque en caso de falta de camas se pueden colocar a los pacientes en cohortes. Esta es la práctica de agrupar juntos a los pacientes infectados con el mismo organismo, y prevenir su contacto con otros pacientes no infectados. Es preferible no colocar pacientes severamente inmunocomprometidos dentro de las cohortes. Cohortes han sido usadas extensivamente para manejar brotes respiratorios como SARS. Colocar personal de salud en cohortes para cuidar un solo tipo de pacientes infectados, parece limitar la transmisión del agente, aunque es difícil de lograr cuando hay escasez de personal. Dentro de las precauciones generales para pacientes sospechosos o confirmados con agentes infecciosos, el CDC recomienda en general: - Precauciones Estandar que implican a) Higiene de Manos, b) Uso de equipo de protección personal dependiendo de las actividades a realizar, c) Prácticas seguras de Endovenosos, y d) Etiqueta/Higiene Respiratorio. - Limpieza y desinfección de todas las aéreas de pacientes es importante para superficies que se tocan, especialmente aquellas cercanas al paciente (agarraderas, cómodas, manijas, lavatorios, superficies y equipos). Desinfectantes o detergentes aprobados son la mejor manera de mantener la limpieza de las habitaciones. - Textiles sucios, incluido ropa de cama, toallas, y ropa de los pacientes pueden estar contaminas. Aunque la probabilidad de transmisión es baja, deben ser manejadas, transportadas y lavadas de manera segura. Medidas principales incluyen: a) No sacudir o manipular los textiles de manera que aerosolizen los agentes, b) Evitar contacto de los textiles con el cuerpo o la ropa de la persona encargada, c) Colocar los textiles en una bolsa de lavandería o contenedor designado. Mantenerlos cerrados para minimizar la dispersión de aerosoles.


Assuntos
Humanos , Dispositivos de Proteção Respiratória/normas , Ventiladores Mecânicos/normas , Infecções por Coronavirus/prevenção & controle , Dispositivos de Proteção dos Olhos/normas , Avaliação da Tecnologia Biomédica , Análise Custo-Eficiência
8.
Cochrane Database Syst Rev ; 4: CD011621, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293717

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/transmissão , Líquidos Corporais/virologia , Simulação por Computador , Doença pelo Vírus Ebola/transmissão , Humanos , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Dispositivos de Proteção Respiratória , Síndrome Respiratória Aguda Grave/transmissão
10.
J Korean Med Sci ; 35(10): e64, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32174063

RESUMO

BACKGROUND: Individual particulate respirator use may offer protection against exposure to particulate matter < 2.5 µm in diameter (PM2.5). Among elderly Korean women, we explored individual particulate respirator use and cardiopulmonary function. METHODS: Recruited in Seoul, Korea, 21 elderly, non-smoking women wore particulate respirators for six consecutive days (exlcuding time spent eating, sleeping, and bathing). We measured resting blood pressure before, during, and after respirator use and recorded systolic and diastolic blood pressure, mean arterial blood pressure, pulse pressure, and lung function. We also measured 12-hour ambulatory blood pressure at the end of the 6-day long experiment and control periods. Additionally, we examined physiological stress (heart rate variability and urinary 8-hydroxy-2'-deoxyguanosine) while wearing the particulate respirators. Person- and exposure-level covariates were also considered in the model. RESULTS: After the 6-day period of respirator use, resting blood pressure was reduced by 5.3 mmHg for systolic blood pressure (P = 0.013), 2.9 mmHg for mean arterial blood pressure (P = 0.079), and 3.6 mmHg for pulse pressure (P = 0.024). However, particulate respirator use was associated with changes in physiological stress markers. A parasympathetic activity marker (high frequency) significantly decreased by 24.0% (P = 0.029), whereas a sympathetic activity marker (ratio of low-to-high frequency) increased by 50.3% (P = 0.045). An oxidative stress marker, 8-hydroxy-2'-deoxyguanosine, increased by 3.4 ng/mg creatinine (P = 0.021) during the experimental period compared with that during the control period. Lung function indices indicated that wearing particulate respirators was protective; however, statistical significance was not confirmed. CONCLUSION: Individual particulate respirator use may prevent PM2.5-induced blood-pressure elevation among elderly Korean women. However, the effects of particulate respirator use, including physiological stress marker elevation, should also be considered. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003526.


Assuntos
Poluentes Atmosféricos , Exposição Ambiental , Material Particulado , Dispositivos de Proteção Respiratória , Idoso , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Poeira , Exposição Ambiental/prevenção & controle , Feminino , Frequência Cardíaca , Humanos , República da Coreia
13.
Waste Manag ; 102: 856-867, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31835063

RESUMO

One of the solutions for decreasing the workers' exposure to bioburden is the use of Filtering Respiratory Protective Devices (FRPD). As such it is important to determine whether these devices are fulfilling their protective role. This is the basis of the current study, aimed at characterizing bioburden retained by 120 FRPD (both in interior layers and in exhalation valves) through culture based-methods and molecular tools and also via analysis of antifungal resistance and mycotoxins profile. Our results show that Gram - Bacteria are present at a higher prevalence than total bacteria in both matrixes. Regarding fungal identification, Chrysonilia sitophila presented the highest prevalence on interior layers (55.1% on malt extract agar (MEA) supplemented with chloramphenicol (0.05%); 59.6% on dichloran-glycerol agar (DG18)), whereas on exhalation valves Aspergillus sp. presented the highest prevalence on MEA (6.8%) and C. sitophila on DG18 (36.3%). Among Aspergillus genera, section Fumigati was the one with the highest prevalence in both matrices. Aspergillus sp. was the most prevalent on exhalation valves (75.0% ITRA) in the screening of azole resistance. Fumigati section was the most abundant Aspergillus sp. detected on the interior layers (33.33%, 40 samples out of 120) and on the exhalation valves (1.66%, 2 samples out of 120). The interior layers and exhalation valves from workers with more waste contact showed an increased exposure to bioburden. This study showed that FRPD can have high levels of bioburden, toxigenic fungal strains and Aspergillus sections with reduced susceptibility to the tested azoles and can be used as a passive sampling method since it mimics the results obtained by active methods in previous studies. The gathered information will be useful to prioritize multiple interventions on workers' education or even on FRPD replacement frequency.


Assuntos
Micotoxinas , Dispositivos de Proteção Respiratória , Aspergillus , Bactérias , Humanos
15.
Diving Hyperb Med ; 49(4): 298-303, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31828749

RESUMO

INTRODUCTION: Scrubbers in closed-circuit rebreather systems remove carbon dioxide (CO2) from the exhaled gas. In an attempt to be more user-friendly and efficient, the ExtendAir® non-granular, pre-formed scrubber cartridge has been developed. The cartridge manufacturer claims twice the absorptive capacity of granular CO2 absorbent, with less variability, lower work of breathing, and reduced exposure to caustic chemicals after a flood. To our knowledge there are no published data that support these claims. METHODS: Cartridge (ExtendAir®) and granular (Sofnolime® 797) scrubbers of equal volume and mass were tested five times in an immersed and mechanically ventilated O2ptima rebreather. Exercise protocols involving staged (90 minutes 6 MET, followed by 2 MET) and continuous (6 MET) activity were simulated. We compared: duration until breakthrough, and variability in duration, to endpoints of 1.0 kPa and 0.5 kPa inspired partial pressure of CO2; inspiratory-expiratory pressure difference in the breathing loop; and pH of eluted water after a 5 minute flood. RESULTS: Mean difference in scrubber endurance was 0-20% in favour of the ExtendAir® cartridge, depending on exercise protocol and chosen CO2 endpoint. There were no meaningful differences in endpoint variability, inspiratory-expiratory pressure in the loop, or pH in the eluted water after a flood. CONCLUSIONS: Cartridge and granular scrubbers were very similar in duration, variability, ventilation pressures, and causticity after a flood. Our findings were not consistent with claims of substantial superiority for the ExtendAir® cartridge.


Assuntos
Dióxido de Carbono/química , Dióxido de Carbono/metabolismo , Mergulho , Humanos , Pressão Parcial , Respiração , Dispositivos de Proteção Respiratória , Água
16.
BMC Infect Dis ; 19(1): 951, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703561

RESUMO

BACKGROUND: In Vietnam, a country with a high tuberculosis (TB) burden, health professionals in both TB-specialized and non-TB-specialized general hospitals have a high risk of acquiring TB. The aims of the present study were to clarify the difficulties in TB infection control at non-TB specialized hospitals and whether any associated risks of latent TB infection exist among health professionals in Vietnam. METHODS: We conducted a cross-sectional study in a national tertiary and general hospital of Hanoi, Vietnam. Participants were health professionals, including physicians, nurses, and other health professionals. We assessed difficulties in TB infection control by conducting a knowledge, attitude, and practice (KAP) survey. We also collected data on the results of tuberculin skin tests (TSTs) conducted during health check-ups for hospital staff to determine whether health professionals had latent TB infection or TB disease. KAP scores were compared among health professional groups (physicians vs. nurses vs. other health professionals). Factors influencing knowledge scores were evaluated using multiple regression analysis. RESULTS: A total 440 health professionals at the study site participated in the KAP survey, and we collected the results of TSTs from a total of 299 health professionals. We observed a high prevalence of latent TB infection (74.2%), especially among participants in the emergency department. Although participants had high KAP scores, some topics were less understood, such as symptoms and risks of TB, proper use of protective equipment such as N95 respirators, and preventing transmission by patients with confirmed or suspected TB. Factors influencing knowledge scores associated with TB were age, a belief that TB is the most important infectious disease, being a medical professional, having previously attended workshops or seminars, and knowing that Vietnam has a high burden of TB. CONCLUSION: In a non-TB specialized hospital of Vietnam, we observed a risk of TB infection among health professionals and difficulties in properly controlling TB infection. Early awareness regarding patients with suspected TB, to apply proper measures and prevent transmission, and education regarding obtaining updated knowledge through scientific information are crucial to enhancing TB infection control in general hospitals of Vietnam.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Hospitais Gerais , Controle de Infecções , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Programas de Rastreamento , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Tuberculose Latente/prevenção & controle , Masculino , Mycobacterium tuberculosis/imunologia , Prevalência , Dispositivos de Proteção Respiratória , Teste Tuberculínico , Vietnã
17.
Undersea Hyperb Med ; 46(4): 447-459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509901

RESUMO

Introduction: The mining and tunneling industries are historically associated with hazardous exposures that result in significant occupational health concerns. Occupational respiratory exposures causing pneumoconiosis and silicosis are of great concern, silicosis being non-curable. This work demonstrates that compressed-air workers (CAWs) performing tunnel hyperbaric interventions (HIs) may be at risk for hazards related to bentonite exposure, increasing the likelihood of developing harmful illnesses including cancer. Bentonite dust inhalation may result in respiratory levels of silica exceeding acceptable industrial hygiene standards. Methods: A qualitative observational exposure assessment was conducted on CAWs while they were performing their HI duties. This was followed by quantitative data collection using personal and area air sample techniques. The results were analyzed and interpreted using standard industrial hygiene principles and guidelines from NIOSH and OSHA. Results: Our work suggests bentonite dust exposure may be an emerging particulate matter concern among CAWs in the tunneling industry. Aerosolized bentonite particles may have potential deleterious effects that include pneumoconiosis and silicosis. Silicosis can result in the development of pulmonary carcinoma. Conclusions: The modern tunneling industry and required hyperbaric interventional tasks represent a potential public health and occupational concern for CAWs. This paper introduces the modern tunneling industry and the duties of CAWs, the hazardous environment in which they perform their duties, and describes the risks and potential harmful health effects associated with these hazardous exposures.


Assuntos
Bentonita/toxicidade , Ar Comprimido , Materiais de Construção/toxicidade , Poeira , Arquitetura de Instituições de Saúde , Exposição Ocupacional/efeitos adversos , Poluentes Ocupacionais do Ar/química , Poluentes Ocupacionais do Ar/toxicidade , Bentonita/química , Indústria da Construção , Materiais de Construção/análise , Segurança de Equipamentos , Filtração/instrumentação , Humanos , Pressão , Pesquisa Qualitativa , Dispositivos de Proteção Respiratória , Estados Unidos , United States Occupational Safety and Health Administration/normas
18.
Artigo em Inglês | MEDLINE | ID: mdl-31480482

RESUMO

Background: Existing evidence shows an urgent need to improve respiratory protective equipment (RPE) use, and more so among migrant workers in small and medium-sized enterprises (SMEs). The study aimed to assess the effectiveness of a behavioral intervention in promoting the appropriate use of RPE among internal migrant workers (IMWs) exposed to organic solvents in SMEs. Methods: A cluster randomized controlled trial was conducted among 1211 IMWs from 60 SMEs in Baiyun district in Guangzhou, China. SMEs were deemed eligible if organic solvents were constantly used in the production process and provided workers with RPE. There were 60 SMEs randomized to three interventions on a 1:1:1 ratio, namely a top-down intervention (TDI), a comprehensive intervention, and a control group which did not receive any intervention. IMWs in the comprehensive intervention received a module encompassing three intervention activities: An occupational health education and training component (lectures and leaflets/posters), an mHealth component in the form of messages illustrative pictures and short videos, and a peer education component. The TDI incorporated two intervention activities, namely the mHealth and occupational health education and training components. The primary outcome was the self-reported appropriate RPE use among IMWs, defined as using an appropriate RPE against organic solvents at all times during the last week before measurement. Secondary outcomes included IMWs' occupational health knowledge, attitude towards RPE use, and participation in occupational health check-ups. Data were collected and assessed at baseline, and three and six months of the intervention. Generalized linear mixed models were performed to evaluate the effectiveness of the trial. Results: Between 3 August 2015 and 29 January 2016, 20 SMEs with 368 IMWs, 20 SMEs with 390 IMWs, and 20 SMEs with 453 IMWs were assigned to the comprehensive intervention, the TDI, and the control group, respectively. At three months, there were no significant differences in the primary and secondary outcomes among the three groups. At six months, IMWs in both intervention groups were more likely to appropriately use RPE than the control group (comprehensive intervention: Adjusted odds ratio: 2.99, 95% CI: 1.75-5.10, p < 0.001; TDI: 1.91, 95% CI: 1.17-3.11, and p = 0.009). Additionally, compared with the control group, the comprehensive intervention also improved all three secondary outcomes. Conclusions: Both comprehensive and top-down interventions were effective in promoting the appropriate use of RPE among IMWs in SMEs. The comprehensive intervention also enhanced IMWs' occupational health knowledge, attitude, and practice. Trial registration: ChiCTR-IOR-15006929. Registered on 15 August 2015.


Assuntos
Indústrias , Exposição Ocupacional/prevenção & controle , Compostos Orgânicos/toxicidade , Dispositivos de Proteção Respiratória , Solventes/toxicidade , Migrantes , Adulto , Terapia Comportamental , China , Análise por Conglomerados , Feminino , Humanos , Masculino , Autorrelato , Adulto Jovem
19.
Molecules ; 24(18)2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31540285

RESUMO

Studies on the functionalization of materials used for the construction of filtering facepiece respirators (FFRs) relate to endowing fibers with biocidal properties. There is also a real need for reducing moisture content accumulating in such materials during FFR use, as it would lead to decreased microorganism survival. Thus, in our study, we propose the use of superabsorbent polymers (SAPs), together with a biocidal agent (biohalloysite), as additives in the manufacturing of polypropylene/polyester (PP/PET) multifunctional filtering material (MFM). The aim of this study was to evaluate the MFM for stability of the modifier's attachment to the polymer matrix, the degree of survival of microorganisms on the nonwoven, and its microorganism filtration efficiency. Scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy were used to test the stability of the modifier's attachment. The filtration efficiency was determined under conditions of dynamic aerosol flow of S. aureus bacteria. The survival rates (N%) of the following microorganisms were assessed: Escherichia coli and Staphylococcus aureus bacteria, Candida albicans yeast, and Aspergillus niger mold using the AATCC 100-2004 method. FTIR spectrum analysis confirmed the pre-established composition of MFM. The loss of the active substance from MFM in simulated conditions of use did not exceed 0.02%, which validated the stability of the modifier's attachment to the PP/PET fiber structure. SEM image analysis verified the uniformity of the MFM structure. Lower microorganism survival rates were detected for S. aureus, C. albicans, and E. coli on the MFM nonwoven compared to control samples that did not contain the modifiers. However, the MFM did not inhibit A. niger growth. The MFM also showed high filtration efficiency (99.86%) against S. aureus bacteria.


Assuntos
Desinfetantes/farmacologia , Viabilidade Microbiana/efeitos dos fármacos , Polipropilenos/síntese química , Aspergillus niger/efeitos dos fármacos , Aspergillus niger/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Candida albicans/crescimento & desenvolvimento , Desinfetantes/química , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Filtração/instrumentação , Microscopia Eletrônica de Varredura , Polímeros , Polipropilenos/química , Dispositivos de Proteção Respiratória/microbiologia , Espectroscopia de Infravermelho com Transformada de Fourier , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento
20.
ACS Appl Mater Interfaces ; 11(39): 36259-36269, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31500411

RESUMO

Well-designed 2D materials with ultrathin structures show great potential for humidity-sensing performance owing to their high surface-volume ratio and a great number of exposed atoms on the surface. However, some sensing elements employed for healthcare applications may be considered as potentially risky, such as inflammation, granuloma formation, and carcinogenesis. Herein, we explored biofriendly humidity-sensing characteristics inspired by the great biocompatibility and conductivity of hyperbranched polyethyleneimine-capped gold nanoparticles and cross-linked with polydopamine from the adhesive proteins in mussels. It was successfully employed into two kinds of wearable devices, sports watches and breathing masks, for real-time recording humidity's fluctuation in expiration and sweat with changes of individual's crying, laughing, nervous, sleeping, training, and cold states. The wearable devices allow us to monitor individual's physical activities and emotional states well, suggesting a promising prospect in safe, reusable, long term, and noncontact human health monitoring applications.


Assuntos
Emoções , Ouro , Nanopartículas Metálicas , Dispositivos de Proteção Respiratória , Dispositivos Eletrônicos Vestíveis , Humanos , Monitorização Fisiológica
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