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1.
Artigo em Inglês | MEDLINE | ID: mdl-34071661

RESUMO

The use of face masks has assumed a leading spot among nonspecific prevention measures during the coronavirus pandemic. The effectiveness of this protective measure depends on the specifics of individual use. The purpose of our study was to analyze the use of respiratory protective equipment (RPE) by medical students during the COVID-19 pandemic. The evaluation of face mask use was based on the results of a survey of medical students at Sechenov University. There were 988 participants in the study: 97.5% used RPE during the pandemic, 89.1% used disposable medical and hygienic face masks, 27.4% used reusable cloth face masks, and 13.2% used respirators. The majority of respondents (75.2%) were found to wear face masks correctly. However, 17.0% of the respondents were found to cover only their mouths with a face mask, while 7.8% reported often shifting their face mask under the chin due to perceived discomfort. Only 25.1% of respondents changed their disposable face mask after 2-3 h of wearing, while 13.0% decontaminated and used it several times. Most cloth face mask users (93.7%) decontaminated their marks, but only 55.7% of respondents did so daily. Face masks were most often worn in medical organizations (91.5%), and 1.4% of respondents did not use respiratory protection anywhere. In conclusion, we consider it necessary to introduce a special module on nonspecific prevention in the discipline of hygiene.


Assuntos
Dispositivos de Proteção Respiratória , Estudantes de Medicina , Humanos , Pandemias/prevenção & controle
3.
J Vis Exp ; (171)2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-34028428

RESUMO

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.


Assuntos
/tratamento farmacológico , Óxido Nítrico/uso terapêutico , Ventiladores Mecânicos , Administração por Inalação , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Óxido Nítrico/administração & dosagem , Dispositivos de Proteção Respiratória
4.
Clin Med (Lond) ; 21(3): e263-e268, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34001582

RESUMO

BACKGROUND: A qualitative fit test using bitter-tasting aerosols is the commonest way to determine filtering face-piece (FFP) mask leakage. This taste test is subjective and biased by placebo. We propose a cheap, quantitative modification of the taste test by measuring the amount of fluorescein stained filter paper behind the mask using image analysis. METHODS: A bitter-tasting fluorescein solution was aerosolised during mask fit tests, with filter paper placed on masks' inner surfaces. Participants reported whether they could taste bitterness to determine taste test 'pass' or 'fail' results. Filter paper photographs were digitally analysed to quantify total fluorescence (TF). RESULTS: Fifty-six healthcare professionals were fit tested; 32 (57%) 'passed' the taste test. TF between the taste test 'pass' and 'fail' groups was significantly different (p<0.001). A cut-off (TF = 5.0 × 106 units) was determined at precision (78%) and recall (84%), resulting in 5/56 participants (9%) reclassified from 'pass' to 'fail' by the fluorescein test. Seven out of 56 (12%) reclassified from 'fail' to 'pass'. CONCLUSION: Fluorescein is detectable and sensitive at identifying FFP mask leaks. These low-cost adaptations can enhance exiting fit testing to determine 'pass' and 'fail' groups, protecting those who 'passed' the taste test but have high fluorescein leak, and reassuring those who 'failed' the taste test despite having little fluorescein leak.


Assuntos
Exposição Ocupacional , Dispositivos de Proteção Respiratória , Análise Custo-Benefício , Fluoresceína , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
5.
J Hosp Infect ; 112: 104-107, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33864893

RESUMO

Personal protective equipment (PPE) is essential for healthcare worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing of HPR-PPE to train HCWs. Survey results indicated that HPR-PPE enabled high-fidelity practise of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic.


Assuntos
/prevenção & controle , Pessoal de Saúde/educação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Estudos de Casos e Controles , Crowdsourcing , Equipamentos Médicos Duráveis , Humanos , Controle de Infecções/instrumentação , Pesquisa Qualitativa , Dispositivos de Proteção Respiratória , Treinamento por Simulação
6.
BMC Infect Dis ; 21(1): 354, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33858372

RESUMO

BACKGROUND AND PURPOSE: COVID-19 pandemic led to wide-spread use of face-masks, respirators and other personal protective equipment (PPE) by healthcare workers. Various symptoms attributed to the use of PPE are believed to be, at least in part, due to elevated carbon-dioxide (CO2) levels. We evaluated concentrations of CO2 under various PPE. METHODS: In a prospective observational study on healthy volunteers, CO2 levels were measured during regular breathing while donning 1) no mask, 2) JustAir® powered air purifying respirator (PAPR), 3) KN95 respirator, and 4) valved-respirator. Serial CO2 measurements were taken with a nasal canula at a frequency of 1-Hz for 15-min for each PPE configuration to evaluate whether National Institute for Occupational Safety and Health (NIOSH) limits were breached. RESULTS: The study included 11 healthy volunteers, median age 32 years (range 16-54) and 6 (55%) men. Percent mean (SD) changes in CO2 values for no mask, JustAir® PAPR, KN95 respirator and valve respirator were 0.26 (0.12), 0.59 (0.097), 2.6 (0.14) and 2.4 (0.59), respectively. Use of face masks (KN95 and valved-respirator) resulted in significant increases in CO2 concentrations, which exceeded the 8-h NIOSH exposure threshold limit value-weighted average (TLV-TWA). However, the increases in CO2 concentrations did not breach short-term (15-min) limits. Importantly, these levels were considerably lower than the long-term (8-h) NIOSH limits during donning JustAir® PAPR. There was a statistically significant difference between all pairs (p < 0.0001, except KN95 and valved-respirator (p = 0.25). However, whether increase in CO2 levels are clinically significant remains debatable. CONCLUSION: Although, significant increase in CO2 concentrations are noted with routinely used face-masks, the levels still remain within the NIOSH limits for short-term use. Therefore, there should not be a concern in their regular day-to-day use for healthcare providers. The clinical implications of elevated CO2 levels with long-term use of face masks needs further studies. Use of PAPR prevents relative hypercapnoea. However, whether PAPR should be advocated for healthcare workers requiring PPE for extended hours needs to evaluated in further studies.


Assuntos
/prevenção & controle , Dióxido de Carbono/análise , Máscaras , Dispositivos de Proteção Respiratória , Adolescente , Adulto , Feminino , Pessoal de Saúde , Humanos , Hipercapnia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
7.
ACS Appl Mater Interfaces ; 13(14): 16084-16096, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33793211

RESUMO

As COVID-19 exemplifies, respiratory diseases transmitted through aerosols or droplets are global threats to public health, and respiratory protection measures are essential first lines of infection prevention and control. However, common face masks are single use and can cause cross-infection due to the accumulated infectious pathogens. We developed salt-based formulations to coat membrane fibers to fabricate antimicrobial filters. Here, we report a mechanistic study on salt-induced pathogen inactivation. The salt recrystallization following aerosol exposure was characterized over time on sodium chloride (NaCl), potassium sulfate (K2SO4), and potassium chloride (KCl) powders and coatings, which revealed that NaCl and KCl start to recrystallize within 5 min and K2SO4 within 15 min. The inactivation kinetics observed for the H1N1 influenza virus and Klebsiella pneumoniae matched the salt recrystallization well, which was identified as the main destabilizing mechanism. Additionally, the salt-coated filters were prepared with different methods (with and without a vacuum process), which led to salt coatings with different morphologies for diverse applications. Finally, the salt-coated filters caused a loss of pathogen viability independent of transmission mode (aerosols or droplets), against both DI water and artificial saliva suspensions. Overall, these findings increase our understanding of the salt-recrystallization-based technology to develop highly versatile antimicrobial filters.


Assuntos
Filtração/instrumentação , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Máscaras , Cloreto de Potássio/química , Cloreto de Sódio/química , Sulfatos/química , Aerossóis , Filtros de Ar , Cristalização , Cinética , Membranas Artificiais , Polipropilenos , Pós , Dispositivos de Proteção Respiratória , Temperatura , Difração de Raios X
8.
Epidemiol Prev ; 45(1-2): 110-116, 2021.
Artigo em Italiano | MEDLINE | ID: mdl-33884849

RESUMO

In Italy, the SARS-CoV-2 pandemic showed the devastating consequences of a widespread biological risk not only for the general population, but also for healthcare workers that diagnose COVID-19 and treat patients. In the set of preventive measures taken to reduce this contagion, a fundamental role in personal protection is played by equipment suitable for preventing the contaminated air inhalation. Despite this severe biological risk during the first epidemic phase, some institutional operating protocols and recommendations have shown limitations and contradictions and, therefore, they must not be repeated. It was observed a widespread inadequate use of respiratory protections, such as surgical masks, which show a low efficacy for health workers; adequate respiratory protective devices are instead rarely used, while their use should have been guaranteed more extensively than it is recommended and noticed, according to the current work hygiene legislation.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional , Pandemias , Dispositivos de Proteção Respiratória , /epidemiologia , /terapia , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Itália/epidemiologia , Pandemias/prevenção & controle , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Medição de Risco
9.
PLoS One ; 16(4): e0249201, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33819279

RESUMO

INTRODUCTION: During viral pandemics, filtering facepiece (FFP) masks together with eye protection form the essential components of personal protective equipment (PPE) for healthcare workers. There remain concerns regarding insufficient global supply and imperfect protection offered by currently available PPE strategies. A range of full-face snorkel masks were adapted to accept high grade medical respiratory filters using bespoke-designed 3D-printed connectors. We compared the protection offered by the snorkel to that of standard PPE using a placebo-controlled respirator filtering test as well as a fluorescent droplet deposition experiment. Out of the 56 subjects tested, 42 (75%) passed filtering testing with the snorkel mask compared to 31 (55%) with a FFP3 respirator mask (p = 0.003). Amongst the 43 subjects who were not excluded following a placebo control, 85% passed filtering testing with the snorkel versus to 68% with a FFP3 mask (p = 0.008). Following front and lateral spray of fluorescence liquid particles, the snorkel mask also provided superior protection against droplet deposition within the subject's face, when compared to a standard PPE combination of FFP3 masks and eye protection (3.19x108 versus 6.81x108 fluorescence units, p<0.001). The 3D printable adaptors are available for free download online at https://www.ImperialHackspace.com/COVID-19-Snorkel-Respirator-Project/. CONCLUSION: Full-face snorkel masks adapted as particulate respirators performed better than a standard PPE combination of FFP3 mask and eye protection against aerosol inhalation and droplet deposition. This adaptation is therefore a promising PPE solution for healthcare workers during highly contagious viral outbreaks.


Assuntos
/prevenção & controle , Pessoal de Saúde , Máscaras , Exposição Ocupacional , Dispositivos de Proteção Respiratória , Adulto , Feminino , Humanos , Masculino
10.
JAMA Netw Open ; 4(4): e216857, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33871614

RESUMO

Importance: The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. Objective: To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. Design, Setting, and Participants: This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. Exposures: All participants performed the speech intelligibility tasks with and without an in-ear communication device. Main Outcomes and Measures: Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. Results: A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). Conclusions and Relevance: This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.


Assuntos
Comunicação , Auxiliares de Audição/normas , Audição , /normas , Salas Cirúrgicas , Dispositivos de Proteção Respiratória/efeitos adversos , Adulto , /prevenção & controle , Canadá , Feminino , Pessoal de Saúde , Humanos , Controle de Infecções/instrumentação , Masculino , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/normas , Melhoria de Qualidade , Treinamento por Simulação , Testes de Discriminação da Fala/métodos
11.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 97-103, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666919

RESUMO

BACKGROUND: Respirators have received much attention since the outbreak of the COVID-19 pandemic. Due to a substantial shortage of the most commonly used respirator, the N95 Filtering Facepiece Respirator (N95), as well as the desire to have added protection while performing aerosol generating procedures (AGPs), dental healthcare personnel (DHCP) have considered alternative respirator options. It is well documented in the medical literature that the Powered Air-Purifying Respirator (PAPR) provides better protection against respiratory pathogens; however, there are no reported cases that describe the use of PAPRs in the dental setting. This survey report evaluates the use of a loose-fitting full facepiece PAPR by different dental providers. OBJECTIVE: To determine if a PAPR can be used in the dental setting and identify any potential barriers to use. METHODS: Eleven DHCP representing general dentistry, dental hygiene, pediatric dentistry, endodontics, orthodontics, oral and maxillofacial surgery and maxillofacial prosthodontics at Walter Reed National Military Medical Center (WRNMMC) and Naval Postgraduate Dental School (NPDS) were asked to wear the MAXAIR PAPR while performing an AGP. They then completed a 14-question survey. RESULTS: There was a 100% response rate. All DHCP with the exception of the endodontist were able to successfully wear the MAXAIR PAPR for the duration of their procedure. All DHCP reported that the PAPR was more comfortable than expected. There were no reports of fogging or hindrance to visibility, breathing was unaffected or enhanced, and the noise level was tolerable. Average time to don and doff the PAPR was 5 minutes. All DHCP were able to wear loupes; some were not able to wear a headlight. Two DHCP reported a history of mild claustrophobia, and both were able to tolerate the PAPR without any issue. 44% preferred the PAPR over the N95. CONCLUSION: This preliminary survey of a loose-fitting PAPR in the dental setting suggests there is a place for PAPRs in the dental community.


Assuntos
/prevenção & controle , Odontologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Medicina Militar , Exposição Ocupacional/prevenção & controle , Dispositivos de Proteção Respiratória , Aerossóis , Humanos
13.
PLoS One ; 16(3): e0247575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33730106

RESUMO

INTRODUCTION: The COVID-19 pandemic has led to widespread shortages of N95 respirators and other personal protective equipment (PPE). An effective, reusable, locally-manufactured respirator can mitigate this problem. We describe the development, manufacture, and preliminary testing of an open-hardware-licensed device, the "simple silicone mask" (SSM). METHODS: A multidisciplinary team developed a reusable silicone half facepiece respirator over 9 prototype iterations. The manufacturing process consisted of 3D printing and silicone casting. Prototypes were assessed for comfort and breathability. Filtration was assessed by user seal checks and quantitative fit-testing according to CSA Z94.4-18. RESULTS: The respirator originally included a cartridge for holding filter material; this was modified to connect to standard heat-moisture exchange (HME) filters (N95 or greater) after the cartridge showed poor filtration performance due to flow acceleration around the filter edges, which was exacerbated by high filter resistance. All 8 HME-based iterations provided an adequate seal by user seal checks and achieved a pass rate of 87.5% (N = 8) on quantitative testing, with all failures occurring in the first iteration. The overall median fit-factor was 1662 (100 = pass). Estimated unit cost for a production run of 1000 using distributed manufacturing techniques is CAD $15 in materials and 20 minutes of labor. CONCLUSION: Small-scale manufacturing of an effective, reusable N95 respirator during a pandemic is feasible and cost-effective. Required quantities of reusables are more predictable and less vulnerable to supply chain disruption than disposables. With further evaluation, such devices may be an alternative to disposable respirators during public health emergencies. The respirator described above is an investigational device and requires further evaluation and regulatory requirements before clinical deployment. The authors and affiliates do not endorse the use of this device at present.


Assuntos
/prevenção & controle , Desenho de Equipamento/instrumentação , Filtração/instrumentação , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Dispositivos de Proteção Respiratória , Ventiladores Mecânicos , Reutilização de Equipamento , Face , Humanos , Teste de Materiais/instrumentação , Exposição Ocupacional/prevenção & controle , Impressão Tridimensional/instrumentação , /patogenicidade
15.
PLoS One ; 16(3): e0248099, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33657178

RESUMO

Since the appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the question regarding the efficacy of various hygiene measures and the use of personal protective equipment (PPE) has become the focus of scientific and above all public discussion. To compare respirators, medical face masks, and cloth masks and determine if it is recommendable to wear face masks to protect the individual wearer of the mask from inhaling airborne particles, we challenged 29 different masks with aerosols and tested the pressure drop as a surrogate for breathing resistance owing to the mask material. We found that Type II medical face masks showed the lowest pressure drop (12.9±6.8 Pa/cm2) and therefore additional breathing resistance, whereas respirators such as the KN95 (32.3±7.0 Pa/cm2) and FFP2 (26.8±7.4 Pa/cm2) showed the highest pressure drops among the tested masks. The filtration efficacy of the mask material was the lowest for cloth masks (28±25%) followed by non-certified face masks (63±19%) and certified medical face masks (70±10%). The materials of the different respirators showed very high aerosol retentions (KN95 [94±4%] and FFP2 [98±1%]). For evaluating the as-worn filtration performance simulating real live conditions each mask type was also tested on a standardized dummy head. Cloth masks and non-EN-certified face masks had the worst as-worn filtration efficacies among the tested masks, filtering less than 20% of the test aerosol. Remarkably, certified type II medical face masks showed similar (p>0.5) as-worn filtration results (47±20%) than KN95 masks (41±4%) and FFP2 masks (65±27%), despite having a lower pressure drop. Face shields did not show any significant retention function against aerosols in our experiment. Our results indicate that it seems recommendable to wear face masks for providing base protection and risk reduction against inhaling airborne particles, in low-risk situations. In our study, especially EN 14683 type II certified medical face masks showed protective effectiveness against aerosols accompanied by minimal additional breathing resistance. FFP2 Respirators, on the other hand, could be useful in high-risk situations but require greater breathing effort and therefore physical stress for users.


Assuntos
/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Máscaras/tendências , Aerossóis , Filtração , Humanos , Modelos Estatísticos , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual/tendências , Dispositivos de Proteção Respiratória/virologia , /patogenicidade
16.
BMC Res Notes ; 14(1): 115, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766095

RESUMO

OBJECTIVES: To reduce the spread of the infection, especially during aerosol generating procedures, we invented "The Cupola", a shield that creates a mechanical barrier around the patient's head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region. RESULTS: The mean number of 0.3 µm particles with no Cupola was 3777 (SD: ± 556), with The Cupola was 2068 (SD: ± 1468) and with the Cupola and Drape was 2031 (SD: ± 1108) (p < 0.015). The mean number of 0.5 µm airborne particles with no Cupola was 65 (SD: ± 7), with The Cupola was 29 (SD: ± 28) and with the Cupola and Drape was 28 (SD: ± 23) (p < 0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.


Assuntos
/prevenção & controle , Assistência Odontológica , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Dispositivos de Proteção Respiratória , Aerossóis , Pessoal de Saúde , Humanos , Projetos Piloto
17.
Artigo em Inglês | MEDLINE | ID: mdl-33567665

RESUMO

BACKGROUND: During the SARS-CoV-2 pandemic, there was shortage of the standard respiratory protective equipment (RPE). The aim of this study was to develop a procedure to test the performance of alternative RPEs used in the care of COVID-19 patients. METHODS: A laboratory-based test was developed to compare RPEs by total inward leakage (TIL). We used a crossflow nebulizer to produce a jet spray of 1-100 µm water droplets with a fluorescent marker. The RPEs were placed on a dummy head and sprayed at distances of 30 and 60 cm. The outcome was determined as the recovery of the fluorescent marker on a membrane filter placed on the mouth of the dummy head. RESULTS: At 30 cm, a type IIR surgical mask gave a 17.7% lower TIL compared with an FFP2 respirator. At 60 cm, this difference was similar, with a 21.7% lower TIL for the surgical mask compared to the respirator. When adding a face shield, the TIL at 30 cm was further reduced by 9.5% for the respirator and 16.6% in the case of the surgical mask. CONCLUSIONS: A safe, fast and very sensitive test method was developed to assess the effectiveness of RPE by comparison under controlled conditions.


Assuntos
/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras/normas , Equipamento de Proteção Individual/normas , Dispositivos de Proteção Respiratória/normas , Aerossóis/efeitos adversos , Humanos , Exposição Ocupacional/prevenção & controle , Ventiladores Mecânicos , Água
18.
Nursing ; 51(3): 32-42, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33587415

RESUMO

ABSTRACT: Protecting nurses in healthcare facilities from SARS-CoV-2 infection is essential for maintaining an adequate nursing force. Foundational guidelines, consistently utilized, protect the nursing staff from infection. This article describes guidelines designed to reduce acute infection and associated morbidity and mortality among nursing staff and improve compliance with infection prevention protocols.


Assuntos
/enfermagem , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Recursos Humanos de Enfermagem , Guias de Prática Clínica como Assunto , /transmissão , Higiene das Mãos , Humanos , Controle de Infecções/métodos , Equipamento de Proteção Individual , Dispositivos de Proteção Respiratória
19.
Auris Nasus Larynx ; 48(3): 525-529, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33446370

RESUMO

OBJECTIVE: Involvement in the tracheostomy procedure for COVID-19 patients can lead to a feeling of fear in medical staff. To address concerns over infection, we gathered and analyzed experiences with tracheostomy in the COVID-19 patient population from all over Japan. METHODS: The data for health-care workers involved in tracheostomies for COVID-19-infected patients were gathered from academic medical centers or their affiliated hospitals from all over Japan. RESULTS: Tracheostomies have been performed in 35 COVID-19 patients with a total of 91 surgeons, 49 anesthesiologists, and 49 surgical staff members involved. Twenty-eight (80%) patients underwent surgery more than 22 days after the development of COVID-19-related symptoms (11: 22-28 days and 17: ≥29 days). Thirty (85.7%) patients underwent surgery ≥ 15 days after intubation (14: 15-21 days, 6: 22-28 days, and 10: ≥29 days). Among the total of 189 health-care workers involved in the tracheostomy procedures, 25 used a powered air-purifying respirator (PAPR) and 164 used a N95 mask and eye protection. As a result, no transmission to staff occurred during the 2 weeks of follow-up after surgery. CONCLUSION: No one involved in tracheostomy procedures were found to have been infected with COVID-19 in this Japanese study. The reason is thought to be that the timing of the surgery was quite late after the infections, and the surgery was performed using appropriate PPE and surgical procedure. The indications for and timing of tracheostomy for severe COVID-19 patients should be decided through multidisciplinary discussion.


Assuntos
/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Insuficiência Respiratória/terapia , Traqueostomia/métodos , Oxigenação por Membrana Extracorpórea , Dispositivos de Proteção dos Olhos , Pessoal de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Japão , Isoladores de Pacientes , Equipamento de Proteção Individual , Respiração Artificial/métodos , Dispositivos de Proteção Respiratória
20.
Swiss Med Wkly ; 151: w20459, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33516162

RESUMO

BACKGROUND: SARS-CoV-2 is a respiratory virus. Transmission occurs by droplets, contact and aerosols. In medical settings, filtering facepiece (FFP) respirators are recommended for use by personnel exposed to aerosol-generating procedures. During the COVID-19 pandemic, the demand for FFP respirators exceeded their supply worldwide and low-quality products appeared on the market, potentially putting healthcare workers at risk. AIMS: To raise awareness about variations in quality of imported FFP respirators in Switzerland during the COVID-19 pandemic, to draw attention to the current directives regulating the market launch of FFP respirators in Switzerland, to provide practical support in identifying suspicious products or documents and, finally, to offer strategies aimed at reducing the distribution of low-quality FFP respirators in the future. METHODS: Three Swiss laboratories, Spiez Laboratory and Unisanté in partnership with TOXpro SA individually set up testing procedures to evaluate aerosol penetration and fit testing of FFP respirators imported into Switzerland during COVID-19 pandemic. Additionally, Spiez Laboratory visually inspected the products, examined the certification documents and crosschecked the product information with international databases. RESULTS: Between 31 March and 15 June 2020, 151 FFP respirators were analysed. The initial assessment performed before testing allowed a reduction of up to 35% in the number of FFP respirators sent to Spiez Laboratory for evaluation, for which product information found to be faulty. After filtration efficiency evaluation and fit testing, 52% and 60% of all products tested by Spiez Laboratory and Unisanté-TOXpro SA, respectively, did not meet the minimum performance requirements established independently by the three Swiss laboratories. CONCLUSION: The demand for FFP respirators exceeded the supply capacity from established suppliers of the Swiss market. New production and import channels emerged, as did the number of poor-quality FFP respirators. FFP respirators remaining in stocks should be checked for conformity before being used, or eliminated and replaced if quality does not meet standards.


Assuntos
/prevenção & controle , /normas , /transmissão , Humanos , Técnicas In Vitro , Rotulagem de Produtos , Dispositivos de Proteção Respiratória/normas , Dispositivos de Proteção Respiratória/provisão & distribução , Suíça
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