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1.
Artigo em Inglês | MEDLINE | ID: mdl-33916609

RESUMO

Dental health care workers around the world are in a constant state of fear and anxiety because they work in a constrained space of the dental practice. During routine dental procedures, they are exposed to aerosol and splatter. These airborne particles pose a great risk of transmitting contagious infections to health care workers and patients, especially in an era of social distancing due to COVID-19. The current study was conducted to evaluate contamination amount, duration, the distance of aerosol, and splatter produced after cavity preparation using a two-hole and four-hole handpiece. The study was performed on a dental manikin in a dental simulation laboratory at the College of Dentistry, King Faisal University Al Ahsa. The dental manikin was set to a reclined position to simulate the clinical operatory position of the patient for dental restorative procedures. Aerosol and splatter were collected on Grade 1 qualitative cotton cellulose filter paper. These were placed on adhesive tape extending from the headrest of the dental manikin in six different directions (2, 4, 6, 8, 10, and 12 o'clock) for up to 60 inches and on certain positions of the operator and assistant such as the chest, head, forearms, upper leg, and inside facemask. Class V cavity preparation was done by the principal investigator at a specific time of 3 min on tooth #11 using a two-hole high-speed handpiece, then on the next day, Class V cavity preparation was performed on tooth #21 by a four-hole handpiece. High volume suction was used throughout the cavity preparation. Immediately after cavity preparation, the first filter paper disc was replaced with new ones in all positions. The second set of filter papers was removed after 30 min. Transparent grids were used to count the contamination area on the filter paper disc. No statistically significant difference was found in the mean amount of aerosol and splatter produced by both handpieces, however, a statistically significant difference was found in an amount of aerosol and splatter produced at a 12, 24, and 36 inches distance immediately after cavity preparation and 30 min after cavity preparation, regardless of the type of handpiece used. It is advisable to refrain from removing the personal protective barriers immediately after the procedure within the vicinity of the dental practice. The use of other adjuncts such as high volume suction to reduce the spread of aerosol and splatter is also recommended.


Assuntos
Aerossóis , Humanos , Sucção
4.
Clin Otolaryngol ; 46(3): 614-618, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33533176

RESUMO

OBJECTIVES: The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the adequacy of PPE in such procedures. DESIGN AND SETTING: Mastoid surgery was simulated in a dry laboratory using a plastic temporal bone, microscope and handheld drill with irrigation and suction. Comparisons of distance of droplet and bone dust contamination and surgeon contamination were made under differing conditions. Irrigation speed, use of microscope and drill burr size and type were compared. MAIN OUTCOME MEASURES: Measurement of the distance of field contamination while performing simulated mastoidectomy and location of surgeon contamination. RESULTS: There was a greater distance field contamination and surgeon contamination without the use of the microscope. Contamination was reduced by using a smaller drill burr and by using a diamond burr when compared to a cutting burr. The use of goggles and a face mask provided good protection for the surgeon. However, the microscope alone may provide sufficient protection to negate the need for goggles. CONCLUSIONS: While the risks of performing mastoid surgery during the coronavirus pandemic cannot be completely removed, they can be mitigated. Such factors include using the microscope for all drilling, using smaller size drill burrs and creating a safe zone around the operating table.


Assuntos
/prevenção & controle , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Mastoidectomia , Equipamento de Proteção Individual , Poeira , Humanos , Modelos Anatômicos , Sucção , Irrigação Terapêutica
5.
Dermatol Surg ; 47(2): 245-249, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565777

RESUMO

BACKGROUND: Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage. PATIENTS AND METHODS: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019. RESULTS: Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001). CONCLUSION: The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control. LEVELS OF EVIDENCE: II.


Assuntos
Anestesia Local , Curetagem/instrumentação , Epinefrina , Hiperidrose/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Vasoconstritores , Anestésicos Locais , Axila/cirurgia , Curetagem/efeitos adversos , Desbridamento , Feminino , Hematoma/etiologia , Humanos , Lidocaína , Masculino , Necrose/etiologia , Necrose/cirurgia , Odorantes , Dor Pós-Operatória/etiologia , Reoperação , Estudos Retrospectivos , Seroma/etiologia , Pele/patologia , Sucção/instrumentação , Infecção da Ferida Cirúrgica/cirurgia
8.
No Shinkei Geka ; 49(1): 52-71, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494051

RESUMO

For safe and reliable cerebral aneurysm clipping, First of all, clean bloodless surgical field and stable and fine movements of micro scissors are necessary. The surgeon must use both hands and determine the best angle before retracting the brain. One of the most basic and important things is that the tips of the clip should be kept continuously in sight until closing clips. We propose a "blading technique" for visualizing the tips of clip blades using a 3-dimensional applier clip manipulation, maintaining contact with the aneurysm while maintaining complementary movement of the suction device in the opposite hand. Before trying to detach the adhering vessels from the aneurysm, the surgeon should consider necessity. Clipping is frequently accomplished using various manipulation techniques with remaining adhesions. This article presents basic clipping and manipulation techniques.


Assuntos
Aneurisma Intracraniano , Encéfalo , Humanos , Aneurisma Intracraniano/cirurgia , Microcirurgia , Procedimentos Neurocirúrgicos , Sucção , Instrumentos Cirúrgicos
9.
J Am Dent Assoc ; 152(2): 157-165, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33494869

RESUMO

BACKGROUND: Aerosol and droplet production is inherent to dentistry. Potential for COVID-19 spread through aerosols and droplets characterizes dentistry as having a high risk of experiencing viral transmission, with necessity for aerosol and droplet mitigation. METHODS: Simulations of restorative treatment were completed on a dental manikin with a high-speed handpiece and high-volume evacuation suction. Variable experimental conditions with use of an extraoral vacuum suction at different distances from the simulated patient's mouth and different vacuum settings were tested to evaluate extraoral suction ability for droplet reduction. RESULTS: Using the extraoral suction unit during dental procedure simulations reduced droplet spatter at the dentist's eye level, as well as the level of the simulated patient's mouth. When the extraoral suction unit was used at level 10 and 4 inches from the simulated patient's mouth, less spatter was detected. CONCLUSIONS: Extraoral suction units are an effective method of reducing droplet spatter during operative dental procedures and can be useful in helping reduce risk of experiencing COVID-19 spread during dental procedures. PRACTICAL IMPLICATIONS: During the pandemic, dentistry and its aerosol-generating procedures were placed on hold. The process to getting back to patient care is multifactorial, including personal protective equipment, patient screening, and mitigating aerosol spread.


Assuntos
Aerossóis , Assistência Odontológica , Humanos , Sucção
10.
Mil Med ; 186(Suppl 1): 364-369, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33499483

RESUMO

INTRODUCTION: Negative Pressure Wound Therapy (NPWT) is a procedure used for nonhealing wounds. In NPWT, a special sealed dressing of large cell foam (>400 µm) or gauze is connected to a pump. Most commonly, negative pressures between -10 and -125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe attributable to removal of the exudate and bacteria, and the stimulation of tissue repair through microdeformation. Reticulated foams with micron-size open cells, Capillary Suction Devices (CSD; 100 to 5 µm) exert capillary suction between 10 and 70 mm of Hg with a multilayered foam dressing. MATERIALS AND METHODS: Yorkshire pigs received 5 surgical excision wounds, 3 cm2, on each side of the back. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 70 mm Hg (CSD-70), and a conventional gauze dressing. The wounds were measured on day 2, and then every 4-5 days thereafter; the total fluid collected by the various dressing over time. RESULTS: By post-wound day 20, the wounds treated with CSD-70 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65% and 45%, respectively. This indicated comparable wound closure efficacies for CSD-70 and NPWT. The average total fluid uptake measured in grams dry weight were similar for CSD-70 and NPWT, 36 and 38 g, respectively, while the values were 24 g for CSD-30 and 12 g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-70 and CSD 30, 24 and 14 g, respectively, were superior to NPWT and gauze 12 and 7 g, respectively. CONCLUSION: This data indicate comparable wound closure efficacies for CSD-70 and NPWT. It is felt that CSD is an effective, safe, and lower cost alternative to vacuum-assisted NPWT.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Animais , Bandagens , Sucção , Suínos , Cicatrização
11.
Braz J Med Biol Res ; 54(3): e10292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33470391

RESUMO

Although some investigations have been performed to determine the effects of transfusion load and suction pressure on renal function during intraoperative salvage autotransfusion, the precise threshold is still undetermined. A total of 625 patients undergoing surgery with the Continuous AutoTransfusion System (CATSplus) were enrolled and divided into groups according to the utilized suction pressure and transfusion volume. Plasma free hemoglobin (FHB) and creatinine clearance (CCr) were assayed to indicate the renal function. Both 0.03 MPa suction (≥4-unit load) and >5 units transfusion changed the levels of FHB and CCr significantly when measured 24 h post-operation compared to pre-operation. Under 0.02 MPa suction (≥4-unit load), the alteration of FHB and CCr returned to normal after 24 h. Under 3 units transfusion, the levels of FHB and CCr at 6 and 12 h post-operation changed significantly compared to pre-operation (P<0.05 or P<0.01, respectively), and this alteration could be restored to normal at 72 h post-operation. After an exhaustive investigation, less than 4 units transfusion and less than 0.03 MPa suction pressure are recommended for intraoperative salvage autotransfusion.


Assuntos
Transfusão de Sangue Autóloga , Transfusão de Sangue , Humanos , Período Pós-Operatório , Sucção
12.
J Stroke Cerebrovasc Dis ; 30(4): 105626, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33516069

RESUMO

OBJECTIVES: In the endovascular treatment of acute cerebral large-vessel occlusion, cervical magnetic resonance angiography (MRA) is a useful modality for assessing the access route. However, we sometimes encounter cases in which not only the internal carotid artery (ICA), but also the common carotid artery (CCA) is poorly visualized, leading to hesitation over which devices and techniques to choose for revascularization. We retrospectively evaluated such cases, focusing on image findings and treatment results. MATERIALS AND METHODS: Data from 96 patients who underwent acute endovascular revascularization from January 2016 to December 2019 were analyzed. We extracted patients with poor CCA visualization on cervical MRA from 35 cases with ICA occlusion, and examined angiographic findings, treatment methods, and outcomes. RESULTS: Poor visualization of the CCA in cervical MRA was observed in 8 cases. All cases displayed atrial fibrillation or sick sinus syndrome. Angiographic findings showed true CCA occlusion in 2 patients and ICA occlusion in 6 patients. Reasons for the inability to visualize the CCA on cervical MRA were speculated to be stenosis of the external carotid artery (ECA), presence of embolism in the ECA, or severe heart failure. In cases of true CCA occlusion, thrombus was aspirated using the balloon guide catheter and good recanalization was obtained. Seven of 8 patients displayed favorable recanalization, with good prognosis after 90 days in 5 patients. CONCLUSIONS: Poor CCA visualization on cervical MRA does not necessarily represent true CCA occlusion. Aspiration of thrombus from a balloon guide catheter is effective for true CCA occlusion.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Estenose das Carótidas/terapia , Angiografia Cerebral , Procedimentos Endovasculares , Angiografia por Ressonância Magnética , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sucção , Trombectomia/efeitos adversos , Resultado do Tratamento
14.
J Dent ; 105: 103565, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33359041

RESUMO

OBJECTIVES: Identify splatter/aerosol distribution from dental procedures in an open plan clinic and explore aerosol settling time after dental procedures. METHODS: In two experimental designs using simulated dental procedures on a mannequin, fluorescein dye was introduced: (1) into the irrigation system of an air-turbine handpiece; (2) into the mannequin's mouth. Filter papers were placed in an open plan clinic to collect fluorescein. An 8-metre diameter rig was used to investigate aerosol settling time. Analysis was by fluorescence photography and spectrofluorometry. RESULTS: Contamination distribution varied across the clinic depending on conditions. Unmitigated procedures have the potential to deposit contamination at large distances. Medium volume dental suction (159 L/min air) reduced contamination in the procedural bay by 53%, and in other areas by 81-83%. Low volume suction (40 L/min air) was similar. Cross-ventilation reduced contamination in adjacent and distant areas by 80-89%. In the most realistic model (fluorescein in mouth, medium volume suction), samples in distant bays (≥5 m head-to-head chair distance) gave very low or zero readings (< 0.0016% of the fluorescein used during the procedure). Almost all (99.99%) of the splatter detected was retained within the procedural bay/walkway. After 10 min, very little additional aerosol settled. CONCLUSIONS: Cross-infection risk from dental procedures in an open plan clinic appears small when bays are ≥ 5 m apart. Dilution effects from instrument water spray were observed, and dental suction is of benefit. Most settled aerosol is detected within 10 min indicating environmental cleaning may be appropriate after this. CLINICAL SIGNIFICANCE: Aerosols produced by dental procedures have the potential to contaminate distant sites and the majority of settled aerosol is detectable after 10 min. Dental suction and ventilation have a substantial beneficial effect. Contamination is likely to be minimal in open plan clinics at distances of 5 m or more.


Assuntos
Pandemias , Aerossóis , Humanos , Sucção
15.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(6): 503-507, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33314858

RESUMO

According to the actual requirements of pediatric intensive care, a suction detection system of pediatric oral secretions integrated with monitoring function is designed. The system has the function of adjustable intermittent attraction. The duration and proportion of intermittent attraction can be adjusted according to the individualized needs of pediatric intensive care. The suction head of pacifier can reduce the mechanical damage to pediatric oral mucosa as much as possible. Meanwhile, the system can detect and monitor the real-time biochemical indexes of the collected oral secretions, which can be used to help the judgement of aspiration and quantitatively evaluate the microcirculation dysfunction.


Assuntos
Secreções Corporais , Boca , Sucção/instrumentação , Criança , Humanos
16.
Chirurgia (Bucur) ; 115(6): 767-774, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378635

RESUMO

Background: Development of seroma after incisional hernia repair is a common complication. Our study aims to compare the outcomes of sublay incisional hernia repairs with or without spray instillation of fibrin glue. Methods: We enrolled fifty patients undergoing incisional hernia repair. In all patients a suction drain was placed in the subcutaneous space. In one group (FG) 4 ml fibrin glue was instilled in the subcutaneous space. In the control group (C) patients did not receive any prevention measure. Wounds fluids were collected on post-operative day 1 (POD) and once daily until drain removal. All patients were followed up by ultrasound on POD 15, 20, 40, 60. Results: Drain fluid production, even if in significantly greater amount in the C group (p 0.01) as compared with the FG group, decreased after POD 1 in both groups. Drain was removed on POD-5 in 80% of FG patients and in 36% of C patients (p 0.01). No infective or bleeding complications were detected. In group FG average hospital stay was of 5.5 ÃÂ+- 2 days versus 7.1 +- 1.5 days in group C (p 0.01). At ultrasounds examination, seroma development was similar among two groups. Conclusions: Spray instillation of fibrin glue during the surgical repair reduces amount of drained fluid and hospital stay without increasing surgical complications. However, seroma occurrence was not significantly reduced.


Assuntos
Adesivo Tecidual de Fibrina/administração & dosagem , Hérnia Ventral , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hérnia Incisional , Seroma/prevenção & controle , Adesivos Teciduais/administração & dosagem , Administração Tópica , Adesivo Tecidual de Fibrina/uso terapêutico , Hérnia Ventral/cirurgia , Humanos , Hérnia Incisional/cirurgia , Tempo de Internação , Seroma/etiologia , Sucção , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento
17.
BMJ Open Respir Res ; 7(1)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33023899

RESUMO

Patients with COVID-19 often need therapeutic interventions that are considered high aerosol-generating procedures. These are either being performed by healthcare providers with potentially inadequate personal protective equipment or the procedures are being delayed until patients clear their viral load. Both scenarios are suboptimal. We present a simple, cost-effective method of creating a portable negative pressure environment using equipment that is found in most hospitals to better protect healthcare providers and to facilitate more timely care for patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Exposição Ocupacional/prevenção & controle , Salas Cirúrgicas/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Campos Cirúrgicos , Aerossóis , Humanos , Pressão , Sucção
18.
J Environ Qual ; 49(2): 440-449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33016427

RESUMO

The use of suctions cups is a common practice for estimating nitrate (NO3 -N) leaching under agricultural systems despite the various uncertainties associated with the approach. One major uncertainty is water flux, which is required for calculating NO3 -N leaching loads from measured concentrations. Another problem is the interpolation of NO3 -N concentrations between measurement days. We investigated how differences in water flux, obtained from two different models (EVACROP and APSIM), affect NO3 -N leaching loads. The effect of interpolation of NO3 -N concentrations based on days or drainage was also addressed. The models were set up according to a 2-yr field experiment with spring barley (Hordeum vulgare L. Quinch) with different levels of N fertilization rates on a loamy soil at Flakkebjerg, Denmark. Due to small differences in measured NO3 -N concentrations between sequential samplings, the method of interpolation did not significantly affect NO3 -N leaching in the two periods investigated. Although there is no standard against which leaching losses from different approaches can be tested, results highlight that the modeling of water uptake as affected by N supply influences the amount of drainage and thus calculated NO3 -N leaching. Therefore, for experiments with varying N fertilization levels, the APSIM model, which accounts for N nutrition on crop water use, is likely more accurate. For common fertilization rates, the simpler EVACROP seems appropriate. Thus, when using suction cup data for testing models or for evaluating mitigation options for nitrate leaching, the use of an appropriate model for estimating water fluxes is important.


Assuntos
Fertilizantes/análise , Nitratos/análise , Agricultura , Solo , Sucção
19.
Neurol India ; 68(5): 1170-1171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109869

RESUMO

Coronavirus disease (COVID-19) has posed immense challenges for healthcare workers, among them are procedures related to suctioning of bodily fluids during surgery or intensive care. These procedures are potentially aerosol-generating and can lead to disease transmission. We have modified the usual suction apparatus in a simple and easy to do manner so that all suctioned material first passes through the 0.1% sodium hypochlorite solution, which is virucidal and decontaminates the suctioned material. This innovation may help in addressing the safety concerns of all healthcare providers working in operation rooms and intensive care units.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sucção/instrumentação , Betacoronavirus , Infecções por Coronavirus/transmissão , Cuidados Críticos , Humanos , Controle de Infecções/métodos , Pneumonia Viral/transmissão , Hipoclorito de Sódio , Sucção/métodos , Procedimentos Cirúrgicos Operatórios
20.
Cochrane Database Syst Rev ; 10: CD013686, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33047816

RESUMO

BACKGROUND: Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk. OBJECTIVES: To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility. DATA COLLECTION AND ANALYSIS: Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity. MAIN RESULTS: We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants). AUTHORS' CONCLUSIONS: We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.


Assuntos
Microbiologia do Ar , Infecções Bacterianas/prevenção & controle , Controle de Infecções Dentárias/métodos , Doenças Profissionais/prevenção & controle , Viroses/prevenção & controle , Adolescente , Adulto , Aerossóis , Idoso , Filtros de Ar , Criança , Pré-Escolar , Contagem de Colônia Microbiana/métodos , Odontologia , Desinfetantes , Humanos , Controle de Infecções Dentárias/economia , Controle de Infecções Dentárias/instrumentação , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Diques de Borracha , Sucção , Adulto Jovem
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