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1.
Breast Dis ; 41(1): 1-3, 2022.
Article in English | MEDLINE | ID: covidwho-1604128

ABSTRACT

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Subject(s)
Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , COVID-19/prevention & control , Catheterization, Central Venous/methods , Infection Control/methods , Patient Safety , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/standards , Central Venous Catheters , Chemotherapy, Adjuvant , Critical Pathways , Female , Humans , Infection Control/standards , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Sentinel Lymph Node Biopsy/standards
2.
J Korean Med Sci ; 36(50): e343, 2021 Dec 27.
Article in English | MEDLINE | ID: covidwho-1594418

ABSTRACT

As hospitals cater to elderly and vulnerable patients, a high mortality rate is expected if a coronavirus disease 2019 (COVID-19) outbreak occurs. Consequently, policies to prevent the spread of COVID-19 in hospital settings are essential. This study was conducted to investigate how effectively national and international guidelines provide recommendations for infection control issues in hospitals. After selecting important issues in infection control, we performed a systematic review and analysis of recommendations and guidelines for preventing COVID-19 transmission within medical institutions at national and international levels. We analyzed guidelines from the World Health Organization, Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and Korea Disease Control and Prevention Agency. Recent guidelines do not provide specific solutions to infection control issues. Therefore, efforts need to be made to devise consistent advice and guidelines for COVID-19 control.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , Practice Guidelines as Topic , SARS-CoV-2 , Health Personnel , Humans
3.
CMAJ Open ; 9(4): E1252-E1259, 2021.
Article in English | MEDLINE | ID: covidwho-1591924

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, universities transitioned to primarily online delivery, and it is important to understand what implications the transition back to in-person activities may have on spread of SARS-CoV-2 in the student population. The specific aim of our study was to provide insights into the effect of timetabling decisions on the spread of SARS-CoV-2 in a population of undergraduate engineering students. METHODS: We developed an agent-based modelling simulation that used a Canadian first-year undergraduate engineering program with an enrolment of 180 students in 5 courses of 12.7 weeks in length. Each course involved 150 minutes of lectures and 110 minutes of tutorials or laboratories per week. We considered several online and in-person timetabling scenarios with different scheduling frequencies and section sizes, in combination with surveillance and testing interventions. The study was conducted from May 1 to Aug. 31, 2021. RESULTS: When timetabling interventions were applied, we found a reduction in the mean number of students who were infected and that a containment of widespread outbreaks could be achieved. Timetables with online lectures and small (1/6 class capacity) tutorial or laboratory sections reduced the mean number of students who were infected by 83% and reduced the risk of large outbreaks that occurred with in-person lectures. We also found that spread of SARS-CoV-2 was less sensitive to class size than to contact frequency when a biweekly timetable was implemented (i.e., alternating online and in-person sections on a biweekly basis). Including a contact-tracing policy and randomized testing to the timetabling interventions helped to contain the spread of SARS-CoV-2 further. Vaccination coverage had the largest effect on reducing the number of students who were infected. INTERPRETATION: Our modelling showed that by taking advantage of timetabling opportunities and applying appropriate interventions (contact tracing, randomized testing and vaccination), SARS-CoV-2 infections may be averted and disruptions (case isolations) reduced. However, given the emergence of SARS-CoV-2 variants, transitions from online to in-person classes should proceed cautiously from small biweekly classes, for example, to manage risk.


Subject(s)
COVID-19/prevention & control , Decision Making, Organizational , Engineering/education , Infection Control/methods , Universities , Adult , COVID-19/epidemiology , Canada , Humans , Students , Time Factors , Universities/organization & administration , Young Adult
4.
CMAJ Open ; 9(4): E1232-E1241, 2021.
Article in English | MEDLINE | ID: covidwho-1591622

ABSTRACT

BACKGROUND: Limited space and resources are potential obstacles to infection prevention and control (IPAC) measures in in-centre hemodialysis units. We aimed to assess IPAC measures implemented in Quebec's hemodialysis units during the spring of 2020, describe the characteristics of these units and document the cumulative infection rates during the first year of the COVID-19 pandemic. METHODS: For this cross-sectional survey, we invited leaders from 54 hemodialysis units in Quebec to report information on the physical characteristics of the unit and their perceptions of crowdedness, which IPAC measures were implemented from Mar. 1 to June 30, 2020, and adherence to and feasibility of appropriate IPAC measures. Participating units were contacted again in March 2021 to collect information on the number of COVID-19 cases in order to derive the cumulative infection rate of each unit. RESULTS: Data were obtained from 38 of the 54 units contacted (70% response rate), which provided care to 4485 patients at the time of survey completion. Fourteen units (37%) had implemented appropriate IPAC measures by 3 weeks after Mar. 1, and all 38 units had implemented them by 6 weeks after. One-third of units were perceived as crowded. General measures, masks and screening questionnaires were used in more than 80% of units, and various distancing measures in 55%-71%; reduction in dialysis frequency was rare. Data on cumulative infection rates were obtained from 27 units providing care to 4227 patients. The cumulative infection rate varied from 0% to 50% (median 11.3%, interquartile range 5.2%-20.2%) and was higher than the reported cumulative infection rate in the corresponding region in 23 (85%) of the 27 units. INTERPRETATION: Rates of COVID-19 infection among hemodialysis recipients in Quebec were elevated compared to the general population during the first year of the pandemic, and although hemodialysis units throughout the province implemented appropriate IPAC measures rapidly in the spring of 2020, many units were crowded and could not maintain physical distancing. Future hemodialysis units should be designed to minimize airborne and droplet transmission of infection.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Disease Outbreaks/prevention & control , Infection Control , Renal Dialysis , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Infection Control/methods , Infection Control/statistics & numerical data , Quebec/epidemiology , Renal Dialysis/adverse effects , Renal Dialysis/methods , Surveys and Questionnaires
6.
Antimicrob Resist Infect Control ; 10(1): 170, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1582005

ABSTRACT

A survey of hospitals on three continents was performed to assess their infection control preparedness and measures, and their infection rate in hospital health care workers during the COVID-19 pandemic. All surveyed hospitals used similar PPE but differences in preparedness, PPE shortages, and infection rates were reported.


Subject(s)
COVID-19/epidemiology , Infection Control/methods , Personnel, Hospital/statistics & numerical data , Hospitals , Humans , Internationality , Pandemics , Personal Protective Equipment , Surveys and Questionnaires
7.
Drug Deliv ; 29(1): 10-17, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1577575

ABSTRACT

Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3-83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, p≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.


Subject(s)
Aerosols , COVID-19 , Drug Delivery Systems , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Nebulizers and Vaporizers , Respiratory Therapy , Aerosols/administration & dosage , Aerosols/adverse effects , COVID-19/prevention & control , COVID-19/transmission , Computer Simulation , Drug Delivery Systems/instrumentation , Drug Delivery Systems/methods , Equipment Design , Humans , Infection Control/methods , Models, Biological , Particle Size , Respiratory Therapy/adverse effects , Respiratory Therapy/instrumentation , Respiratory Therapy/methods , SARS-CoV-2
8.
Semin Respir Crit Care Med ; 42(6): 828-838, 2021 12.
Article in English | MEDLINE | ID: covidwho-1585701

ABSTRACT

The past two decades have witnessed the emergence of three zoonotic coronaviruses which have jumped species to cause lethal disease in humans: severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. MERS-CoV emerged in Saudi Arabia in 2012 and the origins of MERS-CoV are not fully understood. Genomic analysis indicates it originated in bats and transmitted to camels. Human-to-human transmission occurs in varying frequency, being highest in healthcare environment and to a lesser degree in the community and among family members. Several nosocomial outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by World Health Organization as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa, and South Asia. MERS-CoV-2 causes a wide range of clinical presentations, although the respiratory system is predominantly affected. There are no specific antiviral treatments, although recent trials indicate that combination antivirals may be useful in severely ill patients. Diagnosing MERS-CoV early and implementation infection control measures are critical to preventing hospital-associated outbreaks. Preventing MERS relies on avoiding unpasteurized or uncooked animal products, practicing safe hygiene habits in health care settings and around dromedaries, community education and awareness training for health workers, as well as implementing effective control measures. Effective vaccines for MERS-COV are urgently needed but still under development.


Subject(s)
Middle East Respiratory Syndrome Coronavirus , Animals , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Camelus/virology , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Disease Outbreaks/prevention & control , Humans , Infection Control/methods , Middle East Respiratory Syndrome Coronavirus/drug effects , Middle East Respiratory Syndrome Coronavirus/pathogenicity
9.
J Med Internet Res ; 23(2): e22197, 2021 02 25.
Article in English | MEDLINE | ID: covidwho-1573649

ABSTRACT

BACKGROUND: To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. OBJECTIVE: This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. METHODS: This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. RESULTS: Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31). CONCLUSIONS: Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Infection Control/methods , Internet-Based Intervention , COVID-19/epidemiology , Cross-Sectional Studies , Disease Transmission, Infectious/prevention & control , Family Characteristics , Health Behavior , Humans , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom/epidemiology
10.
CMAJ Open ; 9(4): E1175-E1180, 2021.
Article in English | MEDLINE | ID: covidwho-1575909

ABSTRACT

BACKGROUND: Reliable reports on hand hygiene performance throughout the COVID-19 pandemic are lacking as most hospitals continue to rely on direct observation to measure this quality indicator. Using group electronic hand hygiene monitoring, we sought to assess the impact of COVID-19 on adherence to hand hygiene. METHODS: Across 12 Ontario hospitals (5 university and 7 community teaching hospitals), a group electronic hand hygiene monitoring system was installed before the pandemic to provide continuous measurement of hand hygiene adherence across 978 ward and 367 critical care beds. We performed an interrupted time-series study of institutional hand hygiene adherence in association with a COVID-19 inpatient census and the Ontario daily count of COVID-19 cases during a baseline period (Nov. 1, 2019, to Feb. 29, 2020), the pre-peak period of the first wave of the pandemic (Mar. 1 to Apr. 24, 2020), and the post-peak period of the first wave (Apr. 25 to July 5, 2020). We used a Poisson regression model to assess the association between the hospital COVID-19 census and institutional hand hygiene adherence while adjusting for the correlation within inpatient units. RESULTS: At baseline, the rate of hand hygiene adherence was 46.0% (6 325 401 of 13 750 968 opportunities) and this improved beginning in March 2020 to a daily peak of 79.3% (66 640 of 84 026 opportunities) on Mar. 30, 2020. Each patient admitted with COVID-19 was associated with improved hand hygiene adherence (incidence rate ratio [IRR] 1.0621, 95% confidence interval [CI] 1.0619-1.0623). Increasing Ontario daily case count was similarly associated with improved hand hygiene (IRR 1.0026, 95% CI 1.0021-1.0032). After peak COVID-19 community and inpatient numbers, hand hygiene adherence declined and returned to baseline. INTERPRETATION: The first wave of the COVID-19 pandemic was associated with significant improvement in hand hygiene adherence, measured using a group electronic monitoring system. Future research should seek to determine whether strategies that focus on health care worker perception of personal risk can achieve sustainable improvements in hand hygiene performance.


Subject(s)
COVID-19/epidemiology , Hand Hygiene , Health Personnel , Hospitals , Infection Control/statistics & numerical data , COVID-19/virology , Hand Hygiene/methods , Health Impact Assessment , Humans , Infection Control/methods , Public Health Surveillance
12.
Viruses ; 13(12)2021 11 26.
Article in English | MEDLINE | ID: covidwho-1542797

ABSTRACT

To overcome the ongoing coronavirus disease 2019 (COVID-19) pandemic, transmission routes, such as healthcare worker infection, must be effectively prevented. Ultraviolet C (UVC) (254 nm) has recently been demonstrated to prevent environmental contamination by infected patients; however, studies on its application in contaminated hospital settings are limited. Herein, we explored the clinical application of UVC and determined its optimal dose. Environmental samples (n = 267) collected in 2021 were analyzed by a reverse transcription-polymerase chain reaction and subjected to UVC irradiation for different durations (minutes). We found that washbasins had a high contamination rate (45.5%). SARS-CoV-2 was inactivated after 15 min (estimated dose: 126 mJ/cm2) of UVC irradiation, and the contamination decreased from 41.7% before irradiation to 16.7%, 8.3%, and 0% after 5, 10, and 15 min of irradiation, respectively (p = 0.005). However, SARS-CoV-2 was still detected in washbasins after irradiation for 20 min but not after 30 min (252 mJ/cm2). Thus, 15 min of 254-nm UVC irradiation was effective in cleaning plastic, steel, and wood surfaces in the isolation ward. For silicon items, such as washbasins, 30 min was suggested; however, further studies using hospital environmental samples are needed to confirm the effective UVC inactivation of SARS-CoV-2.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , SARS-CoV-2/radiation effects , Ultraviolet Rays , COVID-19/virology , Dose-Response Relationship, Radiation , Hospitals , Humans , SARS-CoV-2/isolation & purification , Time Factors
13.
Adv Skin Wound Care ; 34(12): 651-655, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1528177

ABSTRACT

OBJECTIVE: To determine the frequency of hand dermatitis among nurses during the COVID-19 pandemic and factors affecting its prevalence. METHODS: The research sample consisted of 175 nurses working in state hospitals. Research data were collected via Google survey between September and October 2020. The data were collected using a sociodemographic data collection form, and a self-assessment form was used to determine dermatologic symptoms. RESULTS: The frequency of hand dermatitis among nurses was 70.9%. A statistically significant difference was found between sex, allergy history, and increased frequency of handwashing and the frequency of hand dermatitis. No significant difference in terms of the frequency of hand dermatitis was found between nurses who provided care to patients who were COVID-19 positive versus nurses who provided care to patients who were COVID-19 negative. However, the frequency of washing hands and using hand disinfectants and hand creams was found to have increased significantly during the COVID-19 pandemic compared to the prepandemic period. CONCLUSIONS: The frequency of hand dermatitis increased among nurses during the pandemic. The increased frequency of handwashing during the pandemic poses a risk for hand dermatitis among nurses, although this should not discourage nurses from appropriate hygiene.


Subject(s)
Dermatitis/diagnosis , Hand/physiopathology , Nurses/statistics & numerical data , Adult , COVID-19/prevention & control , COVID-19/transmission , Dermatitis/epidemiology , Female , Hand Disinfection , Humans , Infection Control/instrumentation , Infection Control/methods , Male , Middle Aged , Personal Protective Equipment/adverse effects , Personal Protective Equipment/statistics & numerical data , Prevalence , Turkey/epidemiology
14.
Evid Based Dent ; 21(3): 79, 2020 09.
Article in English | MEDLINE | ID: covidwho-1526068

ABSTRACT

Data sources Medline via PubMed, Scopus, Science Direct, Scielo and Google Scholar were searched without language restriction until 28 May 2020.Study selection Publications on the topic of biosafety measures before, during and after dental practice from observational studies, systematic reviews and literature reviews were included, while letters to the editor, individual opinions and books were excluded.Data extraction and synthesis The authors used a narrative review to describe the findings and grouped them into two categories: those considerations before dental care and those during dental consultation.Results The review was based on 43 publications. Of those, 23 were recent reviews, guidelines, protocols and recommendations from national and international organisations; three were COVID-related original studies and the remainder were pre-COVID publications on handpieces, surface contamination, ventilation, aerosols and airborne spread, ultrasonics, hand washing and dental pain management.Conclusions Patients should conform to COVID-19 screening protocols in order to receive dental care and follow all the procedures in place to prevent transmission while in the dental office.


Subject(s)
Betacoronavirus , Coronavirus Infections , Dental Care , Infection Control , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Infection Control/methods , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
15.
Transplant Proc ; 53(4): 1126-1131, 2021 May.
Article in English | MEDLINE | ID: covidwho-1525970

ABSTRACT

Coronavirus disease 2019 drastically impacted solid organ transplantation. Lacking scientific evidence, a very stringent but safer policy was imposed on liver transplantation (LT) early in the pandemic. Restrictive transplant guidelines must be reevaluated and adjusted as data become available. Before LT, the prevailing policy requires a negative severe acute respiratory syndrome coronavirus 2 real-time polymerase chain reaction (RT-PCR) of donors and recipients. Unfortunately, prolonged viral RNA shedding frequently hinders transplantation. Recent data reveal that positive test results for viral genome are frequently due to noninfectious and prolonged convalescent shedding of viral genome. Moreover, studies demonstrated that the cycle threshold of quantitative RT-PCR could be leveraged to inform clinical transplant decision-making. We present an evidence-adjusted and significantly less restrictive policy for LT, where risk tolerance is tiered to recipient acuity. In addition, we delineate the pretransplant clinical decision-making, intra- and postoperative management, and early outcome of 2 recipients of a liver graft performed while their RT-PCR of airway swabs remained positive. Convalescent positive RT-PCR results are common in the transplant arena, and the proposed policy permits reasonably safe LT in many circumstances.


Subject(s)
COVID-19 Nucleic Acid Testing/standards , COVID-19/diagnosis , Health Policy , Liver Transplantation/legislation & jurisprudence , SARS-CoV-2/genetics , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing/methods , Female , Humans , Infection Control/legislation & jurisprudence , Infection Control/methods , Liver Transplantation/adverse effects , Male , Middle Aged , Postoperative Complications/prevention & control , Postoperative Complications/virology , Preoperative Care/legislation & jurisprudence , Preoperative Care/methods , Reference Values , Tissue Donors , Virus Shedding
16.
Commun Dis Intell (2018) ; 452021 May 27.
Article in English | MEDLINE | ID: covidwho-1524942

ABSTRACT

Abstract: With COVID-19 affecting millions of people around the globe, quarantine of international arrivals is a critical public health measure to prevent further disease transmission in local populations. This measure has also been applied in the repatriation of citizens, undertaken by several countries as an ethical obligation and legal responsibility. This article describes the process of planning and preparing for the repatriation operation in South Australia during the COVID-19 pandemic. Interagency collaboration, development of a COVID-19 testing and quarantining protocol, implementing infection prevention and control, and building a specialised health care delivery model were essential aspects of the repatriation operational planning, with a focus on maintaining dignity and wellbeing of the passengers as well as on effective prevention of COVID-19 transmission. From April 2020 to mid-February 2021, more than 14,000 international arrivals travellers have been repatriated under the South Australian repatriation operations. This paper has implications to inform ongoing repatriation efforts in Australia and overseas in a pandemic situation.


Subject(s)
COVID-19/epidemiology , Infection Control/legislation & jurisprudence , Public Health/legislation & jurisprudence , Quarantine/legislation & jurisprudence , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Testing/methods , COVID-19 Testing/standards , Delivery of Health Care , Humans , Infection Control/methods , International Health Regulations , Pandemics , Public Health/methods , Quarantine/methods , Risk Assessment , Risk Factors , SARS-CoV-2/isolation & purification , South Australia/epidemiology , Travel
18.
Curr Opin Ophthalmol ; 31(5): 374-379, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1511065

ABSTRACT

PURPOSE OF REVIEW: The use of slit lamp shields has been recommended by the American Academy of Ophthalmology as an infection control measure during the coronavirus disease 2019 pandemic. However, there is limited evidence regarding its efficacy to reduce viral transmission risks. We aim to provide an evidence-based approach to optimize the use of slit lamp shields during clinical examination. RECENT FINDINGS: Respiratory droplets from coughing and sneezing can travel up to 50 m/s and over a distance of 2 m, with a potential area of spread of 616 cm. Slit lamp shields confer added protection against large droplets but are limited against smaller particles. A larger shield curved toward the ophthalmologist and positioned closer to the patient increases protection against large droplets. A potential improvement to the design of such shields is the use of hydrophilic materials with antiviral properties which may help to minimize splashing of infectious droplets, reducing transmission risks. These include gold or silver nanoparticles and graphene oxide. SUMMARY: Slit lamp shields serve as a barrier for large droplets, but its protection against smaller droplets is undetermined. It should be large, positioned close to the patient, and used in tandem with routine basic disinfection practices.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Infection Control/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/transmission , Protective Devices , Slit Lamp , COVID-19 , Humans , Infection Control/methods , Pandemics , SARS-CoV-2
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