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1.
Asia Pac J Ophthalmol (Phila) ; 10(2): 142-145, 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33793439

RESUMO

ABSTRACT: Ophthalmologists and patients have an inherent increased risk for transmission of SARS-CoV-2. The human ocular surface expresses receptors and enzymes facilitating transmission of SARS-CoV-2. Personal protective equipment alone provides incomplete protection. Adjunctive topical ocular, nasal, and oral antisepsis with povidone iodine bolsters personal protective equipment in prevention of provider-patient transmission of SARS-CoV-2 in ophthalmology.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Desinfecção/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Povidona-Iodo/uso terapêutico , Administração Oftálmica , Humanos , Soluções Oftálmicas , Equipamento de Proteção Individual , Exame Físico
2.
Br J Radiol ; 94(1121): 20201316, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835838

RESUMO

OBJECTIVE: The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts. METHODS: Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period. RESULTS: 224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19. CONCLUSION: We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes. ADVANCES IN KNOWLEDGE: Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.


Assuntos
/epidemiologia , Neoplasias do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Assintomáticas , /transmissão , Feminino , Fidelidade a Diretrizes , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Risco
3.
Eur J Dermatol ; 31(1): 55-59, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648913

RESUMO

BACKGROUND: Since December 2019, the global population has been experiencing an unprecedented challenge due to Corona virus disease (COVID-19). A pandemic was declared by the World Health Organization on March 11th 2020, with an escalation of new cases worldwide. Dermatology units experienced a reorganization of regular activity, also providing clinical diagnosis and medical assistance to COVID-19-positive patients who developed cutaneous manifestations. OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on Italian dermatologic clinical practice. MATERIALS & METHODS: This was a prospective online survey, consisting of a questionnaire with 35 multiple-choice questions uploaded on the website of the Italian Society of Dermatology and Venereology - SIDeMaST. RESULTS: A total of 136 dermatologists, 78 women (57%) and 58 men (43%), participated in the survey. The mean age was 58 ± 14 years. In total, 60% of participants reported an impact of the pandemic on their practice, in most cases consisting of a remarkable reduction in routine clinical activity (58%). Concern regarding possible infection was evaluated with a score ranging from 0 (no concern) to 5 (extremely concerned): the fear of becoming infected was high (≥3 in 40%), as was the fear of infecting families, colleagues or patients (≥3 points in 45%). CONCLUSION: The COVID-19 pandemic is having a strong impact on dermatology practice in Italy. The identification of critical points may help scientific societies to improve the clinical scenario and create specific strategies to overcome the emergency.


Assuntos
/epidemiologia , Dermatologia/organização & administração , Padrões de Prática Médica , /transmissão , Dermatologistas/psicologia , Medo , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Fatores de Risco , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/terapia
4.
World J Emerg Surg ; 16(1): 14, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752721

RESUMO

BACKGROUND: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. METHOD: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. RESULTS: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion. CONCLUSIONS: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.


Assuntos
/prevenção & controle , Controle de Infecções/normas , Assistência Perioperatória/normas , Procedimentos Cirúrgicos Operatórios/normas , /diagnóstico , /transmissão , /normas , Emergências , Saúde Global , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/métodos , Laparoscopia/normas , Pandemias , Assistência Perioperatória/métodos , Equipamento de Proteção Individual , Procedimentos Cirúrgicos Operatórios/métodos
5.
BMJ Open ; 11(3): e044644, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653758

RESUMO

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


Assuntos
/prevenção & controle , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência à Saúde , Pessoal de Saúde , Humanos , Modelos Teóricos , Pandemias , Equipamento de Proteção Individual
6.
Emergencias ; 33(2): 93-99, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33750049

RESUMO

OBJECTIVES: The main objective was to describe physicians' perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation. MATERIAL AND METHODS: Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually. RESULTS: Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place. CONCLUSION: After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.


Assuntos
Manuseio das Vias Aéreas/métodos , Competência Clínica , Educação Médica Continuada/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laringoscopia/educação , Adulto , Manuseio das Vias Aéreas/instrumentação , /transmissão , Feminino , Humanos , Laringoscopia/instrumentação , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Percepção , Autoeficácia , Gravação em Vídeo
7.
Elife ; 102021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729154

RESUMO

Understanding the effectiveness of infection control methods in reducing and preventing SARS-CoV-2 transmission in healthcare settings is of high importance. We sequenced SARS-CoV-2 genomes for patients and healthcare workers (HCWs) across multiple geographically distinct UK hospitals, obtaining 173 high-quality SARS-CoV-2 genomes. We integrated patient movement and staff location data into the analysis of viral genome data to understand spatial and temporal dynamics of SARS-CoV-2 transmission. We identified eight patient contact clusters (PCC) with significantly increased similarity in genomic variants compared to non-clustered samples. Incorporation of HCW location further increased the number of individuals within PCCs and identified additional links in SARS-CoV-2 transmission pathways. Patients within PCCs carried viruses more genetically identical to HCWs in the same ward location. SARS-CoV-2 genome sequencing integrated with patient and HCW movement data increases identification of outbreak clusters. This dynamic approach can support infection control management strategies within the healthcare setting.


Assuntos
/transmissão , Infecção Hospitalar/transmissão , /genética , Idoso , Busca de Comunicante , Infecção Hospitalar/virologia , Feminino , Pessoal de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Transmissão de Doença Infecciosa do Profissional para o Paciente , Masculino , Sequenciamento Completo do Genoma
8.
Elife ; 102021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33650490

RESUMO

COVID-19 poses a major challenge to care homes, as SARS-CoV-2 is readily transmitted and causes disproportionately severe disease in older people. Here, 1167 residents from 337 care homes were identified from a dataset of 6600 COVID-19 cases from the East of England. Older age and being a care home resident were associated with increased mortality. SARS-CoV-2 genomes were available for 700 residents from 292 care homes. By integrating genomic and temporal data, 409 viral clusters within the 292 homes were identified, indicating two different patterns - outbreaks among care home residents and independent introductions with limited onward transmission. Approximately 70% of residents in the genomic analysis were admitted to hospital during the study, providing extensive opportunities for transmission between care homes and hospitals. Limiting viral transmission within care homes should be a key target for infection control to reduce COVID-19 mortality in this population.


Assuntos
/epidemiologia , Casas de Saúde , /genética , Idoso de 80 Anos ou mais , Surtos de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Transmissão de Doença Infecciosa do Profissional para o Paciente , Masculino , Polimorfismo de Nucleotídeo Único , Análise de Sequência , Fatores de Tempo
9.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 60-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666913

RESUMO

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


Assuntos
/prevenção & controle , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Militares , Equipamento de Proteção Individual , Aerossóis , Humanos
10.
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
12.
Braz Oral Res ; 35: e046, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729296

RESUMO

Several guidelines for dental practice have been published by dental associations and regulatory boards since the beginning of the pandemic. Initially, all non-emergency dental treatment were suspended. Healthcare personnel around the world are gradually expanding back to elective procedures. International updated recommendations alert that professionals must maintain regular observation of local health department reports, ensure personal protective equipment, and screen all patients for COVID-19 signs and symptoms. Telehealth strategies, patient screening, rescheduling when presenting COVID-19 symptoms and/or history of contact with infected people and hand/environment hygiene practices are reinforced. Appropriate cleaning and surface disinfection are mandatory. The dental staff must be trained to use appropriate Personal Protective Equipment (PPE), following a risk assessment and standard precautions: gloves; fluid resistant disposable gown, eye protection (face shield or goggles) and a medical mask. A fit tested N95 or KN95 respirator (or higher) is recommended when aerosol generating procedures are performed. Only essential accompanying persons should attend to dental appointment with the patient and must wear a cloth face covering or facemask. Social distancing and mask wearing by all staff are necessary in all areas of the office. Dental health care providers should keep up to date to the current guidance of clinical practice during the pandemic.


Assuntos
Pandemias , Assistência Odontológica , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle
13.
BMC Ophthalmol ; 21(1): 139, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743634

RESUMO

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.


Assuntos
Centros Médicos Acadêmicos/tendências , Assistência Ambulatorial/tendências , Oftalmopatias/diagnóstico , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Oftalmologia/tendências , Padrões de Prática Médica/tendências , /transmissão , Controle de Doenças Transmissíveis , Humanos , Classificação Internacional de Doenças , Oftalmologia/métodos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Telemedicina/métodos , Estados Unidos
15.
PLoS One ; 16(3): e0248282, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33690699

RESUMO

Compliance with infection prevention and control (IPC) protocols is critical in minimizing the risk of coronavirus disease (COVID-19) infection among healthcare workers. However, data on IPC compliance among healthcare workers in COVID-19 treatment centers are unknown in Ghana. This study aims to assess IPC compliance among healthcare workers in Ghana's COVID-19 treatment centers. The study was a secondary analysis of data, which was initially collected to determine the level of risk of COVID-19 virus infection among healthcare workers in Ghana. Quantitative data were conveniently collected using the WHO COVID-19 risk assessment tool. We analyzed the data using descriptive statistics and logistic regression analyses. We observed that IPC compliance during healthcare interactions was 88.4% for hand hygiene and 90.6% for Personal Protective Equipment (PPE) usage; IPC compliance while performing aerosol-generating procedures (AGPs), was 97.5% for hand hygiene and 97.5% for PPE usage. For hand hygiene during healthcare interactions, lower compliance was seen among nonclinical staff [OR (odds ratio): 0.43; 95% CI (Confidence interval): 0.21-0.89], and healthcare workers with secondary level qualification (OR: 0.24; 95% CI: 0.08-0.71). Midwives (OR: 0.29; 95% CI: 0.09-0.93) and Pharmacists (OR: 0.15; 95% CI: 0.02-0.92) compliance with hand hygiene was significantly lower than registered nurses. For PPE usage during healthcare interactions, lower compliance was seen among healthcare workers who were separated/divorced/widowed (OR: 0.08; 95% CI: 0.01-0.43), those with secondary level qualifications (OR 0.08; 95% CI 0.01-0.43), non-clinical staff (OR 0.16 95% CI 0.07-0.35), cleaners (OR: 0.16; 95% CI: 0.05-0.52), pharmacists (OR: 0.07; 95% CI: 0.01-0.49) and among healthcare workers who reported of insufficiency of PPEs (OR: 0.33; 95% CI: 0.14-0.77). Generally, healthcare workers' infection prevention and control compliance were high, but this compliance differs across the different groups of health professionals in the treatment centers. Ensuring an adequate supply of IPC logistics coupled with behavior change interventions and paying particular attention to nonclinical staff is critical in minimizing the risk of COVID-19 transmission in the treatment centers.


Assuntos
/psicologia , Fidelidade a Diretrizes/tendências , Pessoal de Saúde/psicologia , Adulto , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Feminino , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Conhecimento , Masculino , Pandemias/prevenção & controle , Equipamento de Proteção Individual/tendências , Inquéritos e Questionários , Viroses/transmissão
16.
Simul Healthc ; 16(2): 153-154, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33780966

RESUMO

SUMMARY STATEMENT: In light of the COVID-19 pandemic, protocols to reduce risk of exposure to healthcare teams have been implemented. The use of an acrylic box during intubation and cardiopulmonary resuscitation has been adopted worldwide. A study was conducted to assess the effectiveness of an acrylic box in limiting contamination. The findings indicate that healthcare workers are still vulnerable to exposure despite the use of personal protective equipment (PPE) and an acrylic box. The causes of contamination were related to improper PPE donning and doffing and incomplete coverage by the acrylic box. Institutions should focus on ensuring proper donning and doffing of PPE and incorporating high-fidelity simulation training to prepare teams to resuscitate COVID-19 patients.


Assuntos
/epidemiologia , Reanimação Cardiopulmonar/métodos , Treinamento com Simulação de Alta Fidelidade/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual/normas , Líquidos Corporais , Pessoal de Saúde/educação , Humanos , Controle de Infecções/normas , Pandemias
18.
PLoS One ; 16(3): e0248347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735264

RESUMO

BACKGROUND: Healthcare workers (HCW) are at increased risk of SARS-CoV-2 infection from both patients and other HCW with coronavirus disease 2019 (COVID-19). RT-PCR cycle threshold (Ct) values of SARS-CoV-2 ≤ 34 and the first 7-9 days of symptoms are associated with enhanced infectivity. We determined Ct values and duration of symptoms of HCW with a positive SARS-CoV-2 test. As HCW often assume their greatest risk of acquiring SARS-CoV-2 is working on a COVID-19 unit, we also determined Ct values and symptom duration of inpatients with a positive SARS-CoV-2 test. METHODS: From 6/24/2020-8/23/2020, Ct values and duration of symptoms from 13 HCW, 12 outpatients, and 28 inpatients who had a positive nasopharyngeal swab for SARS-CoV-2 were analyzed. RESULTS: Among HCW with a positive SARS-CoV-2 test, 46.2% (6/13) were asymptomatic and requested testing due to an exposure to someone with COVID-19; 83.3% (5/6) of those exposures occurred in the community rather than in the hospital. The median Ct value of HCW was 23.2, and 84.6% (11/13) had a Ct value ≤ 34. The median Ct value of 29.0 among outpatients with COVID-19 did not significantly differ from HCW. In contrast, inpatients with a positive SARS-CoV-2 test had a median Ct value of 34.0 (p = 0.003), which translated into a median ~1,000-fold lower viral load than observed in HCW. Among those with symptoms related to COVID-19, no (0/6) HCW compared to 50% (6/12) of inpatients had symptoms for at least one week (p = 0.04). CONCLUSIONS: At our institution, asymptomatic COVID-19 accounted for nearly half of the cases among HCW. Symptomatic HCW had high viral loads and short duration of symptoms, both of which are associated with peak infectivity. Infection prevention programs should educate HCW on these findings in an effort to increase adherence to the requirement to maintain six feet separation in workspaces and breakrooms, in addition to consistently wearing personal protection equipment.


Assuntos
/diagnóstico , Pessoal de Saúde , Carga Viral , Adulto , Idoso , /transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pacientes Internados , Pessoa de Meia-Idade , Pacientes Ambulatoriais
19.
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
20.
Pediatr Int ; 63(3): 260-263, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33656224

RESUMO

Coronavirus disease 2019 (COVID-19) has spread worldwide within a short period, and there is still no sign of an end to the pandemic. Management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant women at the time of delivery presents a unique challenge. To fulfill the goal of providing adequate management of such women and their infants, and to decrease the risk of exposure of the healthcare providers, tentative guidelines are needed until more evidence is collected. Practical preventative action is required that takes into account the following infection routes: (i) aerosol transmission from mothers to healthcare providers, (ii) horizontal transmission to healthcare providers from infants infected by their mothers, and (iii) horizontal transmission from mothers to infants. To develop standard operating procedures, briefings/training simulations should be carried out, taking into account the latest information. Briefings should be carefully conducted to clarify the role and procedures. Healthcare providers should wear personal protective equipment. If it is physically possible, neonatal resuscitation should be performed in a separate area next to the delivery room. If a separate area is not available, the infant warmer should be placed at least 2 m away from the delivery table, or partitioned off in the same room. A minimum number of skilled personnel should participate in resuscitation using the latest neonatal resuscitation algorithms.


Assuntos
/transmissão , Salas de Parto , Controle de Infecções/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , /terapia , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Mães , Equipamento de Proteção Individual , Gravidez , Complicações Infecciosas na Gravidez/terapia , Ressuscitação/métodos , Treinamento por Simulação
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