ABSTRACT
BACKGROUND AND AIM: To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and intensive care units (PICU). METHOD(S): We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries. RESULT(S): We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. There was a significant decline reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. CONCLUSION(S): SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. Continual effort and research into the subject should be essential for us to protect the well-being of children.
ABSTRACT
BACKGROUND AND AIM: High contagiousness of SARS-COV-2 is caused by bioaerosols' emission. Clinical situations involving tissue manipulation with high viral load called "aerosol-generating procedures" (AGP) may increase this risk of healthcare providers (HCPs) developing infectious diseases. Our aim was to investigate the impact of an aerosol protection box, the Splash-Guard Caregivers (SGGC), on the presence of viral particles after an AGP. METHOD(S): Prospective observational study conducted between April and June 2020, including the HCPs in charge of children admitted to a Pediatric Intensive Care Unit who tested positive for COVID-19. SGCG (https://rsr-qc.ca/ Splashguard-cg/) was not used systematically and room patients analyzed were divided in: SGCG+ and SGCP-. Virus detection was performed: on the air one meter from the patient's head, also on the air near each HCPs (wearable pumps) and at each HCPs forehead (swab) after an AGP. Samples were analyzed for SARS-COV-2 RNA by qPCR. RESULT(S): Eight batches of samples were performed in the single room of SARS-COV-2+ child: SGCG+ (n=3) and SGCG- (n=5), with five qPCR positive (10.2%) for SARSCOV- 2. Three (11.5%) among 26 analyses from the group SGCG-: in the air before the AGP (n=1), in the air near HCP's head (n=1), and in the HCP forehead swab (n=1). And, two (8.7%) in 23 analysis of SGCG+ group: in the HCP forehead swab (n=1) and in the air near HCP's head (n=1). None of the HCPs were infected by SARS-COV2. CONCLUSION(S): Our results document the presence of SARS-COV2 in infected children environment. The protection effect of SGCG needs additional research.
ABSTRACT
To support the pediatric intensive care unit with the COVID-19 pandemic, we followed a user-centered design process to create a dashboard in a context where direct access to users was impossible. To this end, we applied contextual inquiry, user interview, requirement definition, iterative design with user validation and usability testing in a remote fashion. Being unable to be physically present at the hospital limited our understanding of the context of use, extended the duration of the study and limited the number of interviews and testing sessions. However, we were able to benefit from the experience of our team members, adopt an efficient decision-making method to select appropriate requirements and use remote moderated usability testing to conform our design process to an aggressive timeline. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
AIMS & OBJECTIVES: The SplashGuard-CG (CG for Care Givers) is an advanced barrier enclosure system inspired by Dr Hsien Yung Lai's box to limit the risk of transmission of COVID-19 during intubation. Its use has been extended to all respiratory procedures at risk of generating aerosolized particles (AP).Our objective was to describe the processes of design, improvement and accelerated implementation of the SplashGuard-CG during the challenging context of the COVID-19 pandemic. METHODS: A prospective quality-improvement study was performed. RESULTS: The first step consisted in the design of a prototype within a multidisciplinary living lab approach using computer assisted design (CAD). Multiple trials of the device in various simulated clinical situations enabled us to further improve the prototype. The second step allowed for improvement of the prototype via in situ simulated sessions of patient transport, non-invasive ventilation, and intubations. Simulated training sessions were then organized for medical teams from the various departments involved. Reports were produced throughout and following each session to further refine the SplashGuard-CG design (figure). Finally, dissemination to larger audiences were done by video and in writing. The entire process was completed within a month. CONCLUSIONS: Thanks to a dynamic and interdisciplinary collaboration between healthcare professionals and engineers, the use of CAD, and in-situ simulations, the rapid and secure implementation of a new healthcare device, the SplashGuard-CG, was made possible in times of crisis.
ABSTRACT
AIMS & OBJECTIVES: The Splashguard (SG) is a plexiglass enclosure placed around the patient's head to limit the risk of transmission of COVID-19 during care. The SG was designed to prevent droplet transmission, but can concentrate aerosolized particles inside the SG. The objective was to evaluate the effectiveness of adding suction to prevent the risk of dispersal of aerosolized particles (AP) from critically ill patients on spontaneous ventilation (SV) and non-invasive ventilation (NIV). METHODS: The Topas Aerosol Generator (ATM-220) was connected to the airways of a high-fidelity manikin (SimBabyTM) with a breathing simulator (ASL 5000 tm), to generate a stable concentration of di-ethyl-hexyl-sebacat aerosol particles for 40 s within the SG. The NIV was applied using a Servo-I ventilator with a full-face mask (Figure). The temporal variation of the particle number density and size distribution was measured using a laser aerosol spectrometer (GRIMM 11-R) over the 0.5 μm to 1.0 mm range inside the SG, just above the manikin's head, with and without suction (92 L/min) inside the enclosure. RESULTS: While the aerosol generator is supplying aerosol to the Simbaby airways, the particle concentration increases steadily in the enclosure, with a larger peak in SV than in NIV. The PA peak was greater in SV than in NIV (1.4x106 vs 6.0x105, respectively). Aspiration decreased both the PA peak in SV and NIV, and the time to achieve a 50% reduction in AP concentration. CONCLUSIONS: The application of suction reduced the aerosol concentration inside the SG and may reduce the risk of airborne transmission when handling the SG.