Recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19 / Recommendations for the disinfection of hospital environments exposed to COVID-19

GENERALIDADES: Objetivo y población de las recomendaciones clínicas: Objetivos de las recomendaciones clínicas: Brindar recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19. Ámbito a la cual se aplicarán recomendaciones clínicas: Ambientes hospitalarios expuestos a COVID-19. Usuarios y ámbito de las recomendaciones clínicas: Usuarios de las recomendaciones: Estas recomendaciones están dirigidas a gerentes o directores de los establecimientos de salud, líderes de equipo de trabajo de salud y personal encargado de la limpieza y desinfección de ambientes, para prevenir problemas de infección por COVID-19. Ámbito de las recomendaciones clínicas: El presente documento es de aplicación en las IPRESS de las Redes Asistenciales, Redes Prestacionales y en los Órganos Prestadores Nacionales de EsSalud a nivel nacional. MÉTODOS: 1. Búsqueda y selección de protocolos, guías de práctica clínica y documentos técnicos prévios: El 22 de abril de 2020 se buscaron pautas, protocolos de manejo, y documentos técnicos que aborden procedimientos a seguir para la desinfección de ambientes hospitalarios expuestos a COVID-19, cuya versión a texto completo se encuentre en español o inglés. 2. Formulación de las recomendaciones. Para la formulación de las recomendaciones se revisaron pautas y protocolos encontrados que describieron más ampliamente los procedimientos a realizar para la desinfección de ambientes hospitalarios expuestos a COVID-19. Producto de ello se establecieron las recomendaciones. 3. Desarrollo de las recomendaciones: Persistencia del virus COVID-19 (coronavirus disease 2019). Alcances generales para la desinfección. Medidas de desinfección recurrente. Desinfección según área y condiciones del entorno hospitalário.

Determination of the worst case for cleaning validation of equipment used in the radiopharmaceutical production of lyophilized reagents for 99mTc labeling

ABSTRACT Cleaning validation, a requirement of the current Good Manufacturing Practices (cGMP) for Drugs, consists of documented evidence that cleaning procedures are capable of removing residues to predetermined acceptance levels. This report describes a strategy for the selection of the worst case product for the production of lyophilized reagents (LRs) for labeling with 99mTc from the Instituto de Pesquisas Energéticas e Nucleares (IPEN-CNEN/São Paulo). The strategy is based on the calculation of a "worst case index" that incorporates information about drug solubility, cleaning difficulty, and occupancy rate in the production line. It allowed a reduction in the required number of validations considering the possible manufacturing flow of a given product and the subsequent flow, thus facilitating the process by reducing operation time and cost. The products identified as "worst case" were LRs PUL-TEC and MIBI-TEC.

RESUMO A validação de limpeza é uma exigência dos atuais regulamentos de Boas Práticas de Fabricação de Medicamentos (BPF) e consiste na evidência documentada, que demonstra que os procedimentos de limpeza removem os resíduos em níveis de aceitação pré-determinados. Este estudo apresenta uma estratégia para escolha do produto "pior caso" da linha de produção de reagentes liofilizados para marcação com 99mTc do Instituto de Pesquisas Energéticas e Nucleares (IPEN-CNEN/São Paulo). A estratégia baseia-se no cálculo de um índice denominado "índice para pior caso," que utiliza informações de solubilidade dos fármacos, dificuldade de limpeza dos equipamentos e ocupação dos produtos na linha de produção. A estratégia adotada proporcionou a diminuição no número de validações necessárias, considerando-se as possibilidades de sequências de fabricação de um determinado produto e do produto subsequente, possibilitando a simplificação do processo e redução no tempo e nos custos das atividades envolvidas. Os produtos indicados como pior caso foram os reagentes liofilizados (RL) PUL-TEC e MIBI-TEC.

Repercussão de uma intervenção educativa com agentes comunitários de saúde nas condições ambientais de domicílios de crianças asmáticas / Impact that an educational intervention carried out by community health agents has on environmental conditions in the households of children with asthma

OBJETIVO: Verificar o impacto de uma intervenção educativa problematizadora sobre o controle ambiental para aeroalérgenos, conduzida por agentes comunitários de saúde, nos domicílios de crianças com asma. MÉTODOS: Estudo prospectivo de intervenção. Foram visitados 95 domicílios com crianças (faixa etária de 2-10 anos) com episódios recorrentes de dispneia e sibilância no município de Iguatu (CE). A intervenção educativa envolveu grupos focais com agentes comunitários de saúde com a problematização sobre medidas educativas a serem implementadas. Após a intervenção, 84 domicílios foram revisitados e reavaliados. RESULTADOS: Após a intervenção, houve uma redução significativa na limpeza do piso com vassoura (p = 0,02), no uso de fogão a carvão (p = 0,001) e no número de bichos de pelúcia no domicílio (p = 0,05). Houve uma melhoria significativa no controle ambiental para aeroalérgenos nos quartos das crianças após a intervenção (p = 0,003). CONCLUSÕES: A intervenção educativa mostrou ser uma importante ferramenta junto à população estudada, minimizando os aspectos negativos das condições ambientais dos domicílios das crianças asmáticas.

OBJECTIVE: To determine the impact that an educational intervention employing problem-solving strategies for the environmental control of aeroallergens has on environmental conditions in the households of children with asthma. The intervention was carried out by community health agents. METHODS: This was a prospective intervention study. The community health agents visited 95 households in which there were children (2-10 years of age) who had recurrent episodes of wheezing and dyspnea. All of the households investigated were in the city of Iguatu, Brazil. The educational interventions involved focus groups and community health agents. The focus groups were asked to brainstorm the educational measures to be implemented, in order to devise problem-solving strategies. After the intervention, 84 households were revisited and reevaluated. RESULTS: After the intervention, there was a significant decrease in the use of brooms for cleaning the floor (p = 0.02), in the use of coal-burning stoves (p = 0.001), and in the number of stuffed toys (p = 0.05). There was also a significant post-intervention improvement in the environmental control of aeroallergens in the bedrooms of the children (p = 0.003). Conclusions: The educational intervention applied in this study proved to be an important tool for the target population, improving environmental conditions in the households of children with asthma.

Vacuum cleaning does not sufficiently reduce mite allergens from beddings.

INTRODUCTION: Conflicting results exist with regard to the efficacy of vacuum cleaners on the removal of mite allergens from bedding. OBJECTIVES: The authors prospectively compared a short term efficacy of two types of regular vacuum cleaners (National-N and Hoover-H) with a specialized cleaner (Vorwerk-V) in the removal of mite allergens from mattresses. MATERIAL AND METHOD: Thirty-five dormitory beds with high mite allergen concentrations at the baseline period (month 0) were selected. They were matched into three groups according to group I mite allergen concentrations (N 11 beds, H 12 beds, V 12 beds). Vacuuming was performed on months 1 and 4 by the assigned vacuum cleaner in each group. Immediately after, mattresses were vacuumed by a reference cleaner (another National vacuum cleaner) at both months. Vacuuming was performed over the entire bed for 2 minutes/square meter. Group I mite allergens (sums of Der p 1 and Der f 1) were measured; concentrations and total mite allergens removed by the tested cleaners as well as by the reference cleaner, at various time points, were compared. RESULTS: Ability to remove mite allergens by vacuum cleaners depends on weight of dust removed and also on mite concentrations in the dust samples. Despite the fact that H and V appeared to remove higher mite allergens than N, such differences were not statistically significant (p > 0.05), both at month 1, and 4. Surprisingly, mattress mite concentrations removed by both high capacity cleaner groups (V & H) increased at month 4, whereas, it remained unchanged in the third group (N). This increase led to a concomitant increase in total allergen removed by V and H. Nevertheless, remaining total allergens in the mattresses in V and H, as judged from the amount of allergens obtained by the reference cleaner, increased at month 1 and 4 compared to baseline values (p < 0.05), whereas, no change was observed in N. CONCLUSION: Although high capacity vacuum cleaners removed a large amount of mite allergens from mattresses, they did not sufficiently reduce mattress mite allergen burden as determined by the reference cleaner during this short term study.