Articles: personal-protective-equipment.
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There is disagreement between international guidelines on the level of personal protective equipment (PPE) required for chest compressions for patients with suspected COVID-19. This discrepancy centres on whether they are considered to be an aerosol-generating procedure (AGP), thus requiring airborne protection to prevent transmission to healthcare workers (HCWs). The need to don higher-level PPE has to be weighed against the resulting delay to emergency treatment. ⋯ One systematic review concluded that chest compressions were not an AGP. Two simulated studies (released as preprints) potentially demonstrate aerosol generation. Given that there is evidence for infection transmission during chest compressions, we conclude that a precautionary approach with appropriate PPE is necessary to protect HCW from contracting a potentially fatal infection.
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Disease-a-month : DM · Sep 2020
ReviewDental care and personal protective measures for dentists and non-dental health care workers.
As a pathogen spread primarily by the respiratory route COVID-19 infection not only poses significant risks to health care workers, but to dentists and dental health care workers, owing to the potential prolonged exposure and proximity to patients. This holds true for non-dentist health care workers who often in the setting of emergency departments and urgent care centers are tasked with addressing oral symptoms including abscesses, damaged teeth, jaw injuries and other dental urgencies. ⋯ In this brief review, protective measures to reduce the risk of COVID-19 infection for dentists and non-dentist health care providers will be introduced. This includes patient evaluation, personal and patient protective equipment use, sterilization and disinfection protocols.
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Anesthesia and analgesia · Sep 2020
ReviewAirway management in the operating room and interventional suites in known or suspected COVID-19 adult patients: a practical review.
Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). ⋯ Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.
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Transporting patients with communicable diseases is common in critical care transport operations. At Ornge, Ontario's critical care transport provider, 13.7% of patients required contact, droplet, or airborne precautions during transport in 2019-2020. ⋯ Success in safety requires a robust system of hazard identification and adherence to generally accepted methods of hazard control. This commentary will discuss some of the administrative and engineering controls, as well as the personal protective equipment (PPE) strategies deployed at Ornge.