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1.
Taiwan J Obstet Gynecol ; 59(6): 795-800, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33218391

RESUMO

The spread of COVID-19 has resulted in a high risk of infection in hospitals worldwide. The medical staff in emergency rooms, in particular, have borne the brunt of the pandemic, and strict protection measures are needed to avoid infection in these units. Taiwan as a whole has performed extremely well in this epidemic, an achievement that has been acknowledged internationally. This success can be attributed to the Taiwan Epidemic Prevention Management Center's extensive experience and courageous strategy. The emergency department professionals of all hospitals, in conjunction with the outstanding performance of the center's policy, have also done much to control the infection's spread. However, excessive protection can also negatively affect patients' safety and the quality of medical care, especially for pregnant and parturient women. This article uses two actual cases from a medical center in northern Taiwan to discuss the impact of COVID-19 on pregnant women. This case study serves to highlight that, to ensure more effective coordination during severe epidemics, a comprehensive infection prevention plan should be formulated. In addition, pregnant women's human rights must be safeguarded so that various protective mechanisms can be effectively used to achieve win-win solutions. Hospitals need to plan their production methods and timing in advance for when pregnant patients are in critical condition. The findings include that obstetricians recommend caesarean sections as a safer method in during epidemics. Emergency room physicians and obstetricians should also actively assist mothers prepare for birth to enhance maternal and fetal safety.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/normas , Pandemias/prevenção & controle , Assistência Perinatal/normas , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Betacoronavirus , Cesárea/normas , Infecção Hospitalar/virologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Obstetrícia/normas , Gravidez , Complicações Infecciosas na Gravidez/virologia , Taiwan/epidemiologia
2.
PLoS One ; 15(11): e0242212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180833

RESUMO

BACKGROUND: Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. OBJECTIVE: To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. METHODS: An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. RESULTS: Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. DISCUSSION/CONCLUSION: This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.


Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/economia , Estudos de Tempo e Movimento , Algoritmos , Técnica Delfos , Desinfecção , Higiene das Mãos , Humanos , Programas de Rastreamento , Equipamento de Proteção Individual , Saneamento
3.
J Prev Med Hyg ; 61(3): E301-E303, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33150218

RESUMO

The new SARS-CoV-2/COVID-19 emergency has imposed new disinfection and sanitation measures of work environments also to beauty and health professional workers and in this context ozone shows growing interest. Ozone has proven to be highly effective in killing bacteria, fungi, and molds and inactivating viruses both on the surfaces and suspended in the air. Ozone is proven to be effective also for the inactivation of the SARS virus, while for the novel SARS-CoV-2 it is supposed that it be equally effective but specific studies are needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Controle de Infecções/métodos , Ozônio/química , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Humanos , Raios Ultravioleta
4.
Rev Esp Salud Publica ; 942020 Nov 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33174539

RESUMO

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Odontólogos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Betacoronavirus , Infecção Hospitalar/prevenção & controle , Odontologia/organização & administração , Humanos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Espanha/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33050590

RESUMO

In addition to looking for effective drugs and a vaccine, which are necessary to save and protect human health, it is also important to limit, or at least to slow, the spread of coronavirus. One important element in this action is the use of individual protective devices such as filtering facepiece masks. Currently, masks that use a mechanical filter, such as a HEPA (High Efficiency Particulate Air) filter, are often used. In some countries that do not have a well-developed healthcare system or in exceptional situations, there is a real and pressing need to restore filters for reuse. This article presents technical details for a very simple device for sterilization, including of HEPA polymer filters. The results of biological and microscopic tests confirming the effectiveness of the sterilization performed in the device are presented. The compact and portable design of the device also allows its use to disinfect other small surfaces, for example a small fragment of a floor, table, or bed.


Assuntos
Microbiologia do Ar , Infecção Hospitalar/prevenção & controle , Filtração , Máscaras , Esterilização/métodos , Raios Ultravioleta , Humanos
6.
Anesth Analg ; 131(5): 1342-1354, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079853

RESUMO

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.


Assuntos
Anestesia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Exposição por Inalação/prevenção & controle , Intubação Intratraqueal , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Anestesia/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Contaminação de Equipamentos/prevenção & controle , Dispositivos de Proteção dos Olhos , Higiene das Mãos , Interações Hospedeiro-Patógeno , Humanos , Exposição por Inalação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Segurança do Paciente , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Fatores de Proteção , Dispositivos de Proteção Respiratória , Medição de Risco , Fatores de Risco , Vestimenta Cirúrgica
8.
J Glob Health ; 10(2): 020507, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110590

RESUMO

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration: Registered in ClinicalTrials.gov: NCT04344197.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Infecções por Coronavirus/transmissão , Infecção Hospitalar/virologia , Estudos Transversais , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Programas de Rastreamento/normas , Pneumonia Viral/transmissão , Políticas , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Inquéritos e Questionários
10.
PLoS One ; 15(10): e0239744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057417

RESUMO

BACKGROUND: Globally, health care-associated infections had become serious public health importance. Compliance with standard safety precaution is effective and inexpensive measure to improve quality of healthcare in reducing occurrence of healthcare associated infections. In developing countries, like Ethiopia adherence to recommended standard safety precaution is scanty. OBJECTIVE: To assess level of compliance with standard safety precaution and associated factors among healthcare workers in Hawassa comprehensive specialized hospital Southern Ethiopia. METHODS: An institutional based cross-sectional study was conducted at Hawassa comprehensive specialized hospital. Data were collected by using self-administered questionnaire. Study participants were allocated proportionally based on their profession by using stratified random sampling method. Data were entered and analyzed by using SPSS version 20.0. Bi-variable analysis and multi variable logistic regression model were used to check which variables were associated with dependent variable. P-values ≤ 0.05 were considered statistically significant. In this study the overall compliance with standard safety precaution among healthcare workers were only 56.5%. Being female healthcare worker AOR: 2.76(1.34, 5.54), married healthcare workers AOR: 4.2(2, 9.03), accessibility of safety box AOR: 3.4(1.6, 7.17), HCWs had perceived IP training AOR: 3.99(1.46, 10.9), availability of tape water AOR: 2.68(1.15, 6.2) and healthcare workers had internal infection prevention and control supportive supervision AOR: 5.8(2.54, 13.48) associated with compliance with standard safety precaution. CONCLUSION: According to findings of the current study, overall level of compliance with standard SP among HCWs considered to be very low. Factors such as healthcare workers being female, accessibility of safety box, availability of running tape water, training and supportive supervision were independent predictors of compliance with standard safety precaution. Thus ensuring availability and accessibility of safety precaution materials and regular observing and supervising healthcare workers' practices are highly recommended.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Etiópia , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
11.
BMC Infect Dis ; 20(1): 799, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115427

RESUMO

BACKGROUND: Clostridioides difficile infection (CDI) is one of the most common healthcare infections. Common strategies aiming at controlling CDI include antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions. Mathematical models provide a framework to evaluate control strategies. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting. METHODS: We developed an agent-based model that simulates the transmission of C. difficile in medical wards. This model explicitly incorporates healthcare workers (HCWs) as vectors of transmission, tracks individual patient antibiotic histories, incorporates varying risk levels of antibiotics with respect to CDI susceptibility, and tracks contamination levels of ward rooms by C. difficile. Interventions include two forms of antimicrobial stewardship, increased environmental decontamination through room cleaning, improved HCW compliance, and a preliminary assessment of vaccination. RESULTS: Increased HCW compliance with CDI patients was ranked as the most effective intervention in decreasing colonizations, with reductions up to 56%. Antibiotic stewardship practices were highly ranked after contact precaution compliance. Vaccination and reduction of high-risk antibiotics were the most effective intervention in decreasing CDI. Vaccination reduced CDI cases to up to 90%, and the reduction of high-risk antibiotics decreased CDI cases up to 23%. CONCLUSIONS: Overall, interventions that decrease patient susceptibility to colonization by C. difficile, such as antibiotic stewardship, were the most effective interventions in reducing both colonizations and CDI cases.


Assuntos
Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/transmissão , Clostridium difficile/efeitos dos fármacos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Análise de Sistemas , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Clostridium difficile/imunologia , Infecção Hospitalar/microbiologia , Higiene das Mãos , Pessoal de Saúde , Humanos , Controle de Infecções/métodos , Modelos Teóricos , Vacinação
12.
Pan Afr Med J ; 37: 28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062129

RESUMO

COVID-19 is a rapidly growing pandemic that has grown from a few cases in Wuhan, China to millions of infections and hundreds of thousands of deaths worldwide within a few months. Sub-Saharan Africa is not spared. Radiology has a key role to play in the diagnosis and management of COVID-19 as literature from Wuhan and Italy demonstrates. We therefore share some critical knowledge and practice areas for radiological suspicion and diagnosis. In addition, emphasis on how guarding against healthcare acquired infections (HAIs) by applying "red" and "green" principle is addressed. Given that pandemics such as COVID-19 can worsen the strain on the scantily available radiological resources in this region, we share some practical points that can be applied to manage these precious resources also needed for other essential services. We have noted that radiology does not feature in many main COVID-19 guidelines, regionally and internationally. This paper therefore suggests areas of collaboration for radiology with other clinical and management teams. We note from our local experience that radiology can play a role in COVID-19 surveillance.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Área de Atuação Profissional/tendências , Radiologia/organização & administração , África ao Sul do Saara/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Surtos de Doenças/ética , Surtos de Doenças/prevenção & controle , Recursos em Saúde , Humanos , Conhecimento , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia
13.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026199

RESUMO

Lombardy was violently hit by Covid-19 between the end of February and the beginning of March 2020. On 09.05.2020 there were 81225 total registered Covid-19+ cases (8051 / million inhabitants) with 14924 deaths (1479 deaths / million inhabitants). The province of Cremona presented a higher number of Covid-19+ cases and a worse relative mortality than the already high regional average. Patients on regular hemodialysis treatment present a high risk of infection due to the co-pathologies present, while healthcare workers may represent a risk for themselves and for the patients, due to the treatment environment and the close contact with them. All patients and healthcare workers of the Dialysis Center in Crema were evaluated (oro-pharyngeal swab for viral RNA research, qualitative anti-Covid-19 antibodies, quantitative IgG antibodies, co-pathologies), regardless of the symptomatology, over a 60-day period. Hemodialysis patients have a risk of infection that is 12.7 times that of the local population, while healthcare workers outperform the patients for Covid-positivity (30.3% vs 21.6%). Lethality in infected patients is high (31% of Covid-19+ subjects), while it is zero among healthcare professionals. The antibody response (qualitative and quantitative) in Covid-19+ patients is adequate, when compared to that of Covid-19+ healthcare staff. In our Center, the most critical phase lasted about 45 days but, thanks to the measures taken, it was possible to make the dialysis area Covid-free, as it remains after 128 days.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Falência Renal Crônica/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Diálise Renal , Adulto , Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Emergências , Feminino , Pessoal de Saúde , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Itália/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Orofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Risco , Taxa de Sobrevida
14.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026201

RESUMO

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Transplante de Rim/enfermagem , Pandemias , Pneumonia Viral/enfermagem , Guias de Prática Clínica como Assunto , Diálise Renal/enfermagem , Insuficiência Renal Crônica/enfermagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção , Desinfecção das Mãos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Resíduos de Serviços de Saúde , Processo de Enfermagem/normas , Registros de Enfermagem , Pandemias/prevenção & controle , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Precauções Universais
15.
Ital J Pediatr ; 46(1): 149, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032650

RESUMO

The rapid spread of the COVID-19 outbreak in Italy has dramatically impacted the National Healthcare System, causing the sudden congestion of hospitals, especially in Northern Italy, thus imposing drastic restriction of almost all routine medical care. This exceptional adaptation of the Italian National Healthcare System has also been felt by non-frontline settings such as Pediatric Orthopaedic Units, where the limitation or temporary suspension of most routine care activities met with a need to maintain continuity of care and avoid secondary issues due to the delay or suspension of the routine clinical practice. The Italian Society of Pediatric Orthopaedics and Traumatology formulated general and specific recommendations to face the COVID-19 outbreak, aiming to provide essential care for children needing orthopaedic treatments during the pandemic and early post-peak period, ensure safety of children, caregivers and healthcare providers and limit the spread of contagion.


Assuntos
Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto/normas , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Itália , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Procedimentos Ortopédicos/métodos , Ortopedia/normas , Segurança do Paciente , Pediatria/normas , Sociedades Médicas/normas , Traumatologia/normas
16.
Clin Microbiol Rev ; 34(1)2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33115724

RESUMO

Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.


Assuntos
Aerossóis/análise , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Pandemias/prevenção & controle , Material Particulado/análise , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Betacoronavirus , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Pessoal de Saúde/estatística & dados numéricos , Humanos , Modelos Biológicos , Ventilação
18.
Br J Surg ; 107(13): 1708-1712, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33031569

RESUMO

This study used a national administrative database to estimate perioperative SARS-CoV-2 infection risk, and associated mortality, relative to nosocomial transmission rates. The impact of nosocomial transmission was greatest after major emergency surgery, whereas laparoscopic surgery may be protective owing to reduced duration of hospital stay. Procedure-specific risk estimates are provided to facilitate surgical decision-making and informed consent. Estimated risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/transmissão , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Controle de Infecções/métodos , Tempo de Internação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infecção da Ferida Cirúrgica/mortalidade , Causas de Morte , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/métodos , Emergências , Feminino , Humanos , Incidência , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Prognóstico , Medição de Risco , Infecção da Ferida Cirúrgica/prevenção & controle , Análise de Sobrevida
19.
Biomed Res Int ; 2020: 8469560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062702

RESUMO

Objective: To understand how to implement proactive prevention measures among healthcare professionals for preventing potential nosocomial infection. Methods: 91 healthcare professionals confirmed with the COVID-19 infection were collected, and clinical characteristics and epidemiological data were evaluated. Results: Among the cases, 77 cases (84.6%) were confirmed by the viral nucleic acid test, and the other 14 cases were diagnosed by the clinical investigation. Ground glass opacity and bilateral shadows distribution were observed in 78 cases (85.6%). 56 cases (61.5%) were admitted into Zhongnan Hospital and subjected to antiviral treatment. 73 of a total of 91 cases (80.2%) with a median incubation period of 3 days (IQR, 2 to 6) reported close contact history with patients with the COVID-19 infection. The most common symptoms at the onset of illness were fever (66 cases, 72.5%) and cough (54 cases, 59.3%). The initial positive rate of the CT scan and RT-PCR assay were 84.6% and 48.4%, respectively (P < 0.01). There were 50 cases occurred during the early stage (before Jan 20, 2020), whereas 41 cases occurred at a late stage (after Jan 20, 2020). In the early stage, the most common route of exposure to COVID-19 was via direct care in the absence of any invasive procedure. By contrast, 37 healthcare professionals infected with COVID-19 in the late stage were confirmed to have been exposed via aerosol-generating procedures. Conclusion: Identification of the asymptomatic individuals in healthcare settings and prompt response when a suspicious case is considered may render effective control of the nosocomial infection during this pandemic.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/fisiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Pessoal de Saúde , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Adulto , Doenças Assintomáticas , China/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Estudos Retrospectivos
20.
Assist Inferm Ric ; 39(3): 122-129, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-33077981

RESUMO

. The reorganization of the strategies of a surgical department and the nosocomial diffusion of Covid-19. INTRODUCTION: During the SARS-CoV2 pandemic, preventive measures and patients' selection were adopted to allow the treatment of non-deferrable oncological and trauma cases and to contain hospital diffusion of the virus. The reorganization of the ward management associated to the training of healthcare providers are the first available interventions. AIM: To describe the interventions implemented to limit the spread of virus during the peak of pandemic in a high daily turn-over 25 beds surgical ward (9 patient admitted per day/mean duration of hospital stay 2.3 days). METHOD: Description of the interventions implemented and of the admissions from March 9 to May 18 2020, and the swab results. RESULTS: 392 patients were treated in the period considered (342 were scheduled cases - 50 urgent cases; 364 were adults and 28 children). All scheduled patients underwent a screening survey, 5% of those contacted showed a risk factor at the interview and were rescheduled; 190 patients underwent a preoperative screening swab, all with negative results. None of healthcare providers was positive to swabs. CONCLUSIONS: The prompt application of preventive measures and patients screening (preoperative interview and screening swab) possibly allowed to control the spread of SARS-CoV2 in our hospital. Sharing our experience would allow to find consensus to guarantee the safety for patients and healthcare workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Programas de Rastreamento/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Centro Cirúrgico Hospitalar/organização & administração , Adulto , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/virologia , Humanos , Tempo de Internação , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Fatores de Risco , Inquéritos e Questionários
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