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Health Aff (Millwood) ; 39(10): 1792-1798, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1177766


Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership's work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.

Conducción de Automóvil/legislación & jurisprudencia , Infecciones por Coronavirus/prevención & control , Concesión de Licencias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Administración de la Seguridad/organización & administración , Interfaz Usuario-Computador , Adolescente , Infecciones por Coronavirus/epidemiología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Vehículos a Motor/estadística & datos numéricos , Ohio , Pandemias/estadística & datos numéricos , Philadelphia , Proyectos Piloto , Neumonía Viral/epidemiología , Transportes/métodos , Adulto Joven
Nursing (Säo Paulo) ; 23(268): 4636-4645, set.2020.
Artículo en Portugués | LILACS (Américas) | ID: covidwho-1022450


Objetivo: Evidenciar os fatores determinantes para adesão das medidas de biossegurança pela equipe de Enfermagem na Unidade de Terapia Intensiva. Método: Estudo de revisão sistemática, que usou o instrumento Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada a partir de artigos publicados no período de 2004 a 2019, por dificuldade de encontrar publicações em menor período acerca da temática deste estudo. Resultados: O conhecimento e as ações de promoção e prevenção, como a lavagem de mãos e o uso de Equipamento de Proteção Individual, além de recursos físicos, são fatores determinantes para adesão às medidas de biossegurança na UTI. Conclusão: As medidas de biossegurança garantem a segurança do paciente, e, por isso, é importante que os profissionais sejam capacitados regularmente para prevenir dificuldades e falhas de adesão com as medidas de biossegurança o que pode colocar em risco o paciente e o profissional da enfermagem.(AU)

Objective: To highlight the determining factors for adherence to biosafety measures by the Nursing team in the Intensive Care Unit. Method: Systematic review study, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) instrument. The search was carried out from articles published from 2004 to 2019, due to the difficulty of finding publications in a shorter period on the theme of this study. Results: Knowledge and promotion and prevention actions, such as hand washing and the use of Personal Protective Equipment, in addition to physical resources, are determining factors for adherence to biosafety measures in the ICU. Conclusion: Biosafety measures guarantee patient safety, and, therefore, it is important that professionals are trained regularly to prevent difficulties and failures in adherence to biosafety measures, which can put the patient and the nursing professional at risk. (AU)

Objetivo: Resaltar los determinantes de la adherencia a las medidas de bioseguridad por parte del equipo de Enfermería de la Unidad de Cuidados Intensivos. Método: Estudio de revisión sistemática, utilizando el instrumento Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se realizó a partir de artículos publicados de 2004 a 2019, debido a la dificultad de encontrar publicaciones en un período más corto sobre la temática de este estudio. Resultados: El conocimiento y las acciones de promoción y prevención, como el lavado de manos y el uso de Equipos de Protección Personal, además de los recursos físicos, son factores determinantes para el cumplimiento de las medidas de bioseguridad en la UCI. Conclusión: Las medidas de bioseguridad garantizan la seguridad del paciente, por lo que es importante que los profesionales se capaciten periódicamente para prevenir dificultades y fallas en la adherencia a las medidas de bioseguridad, que pueden poner en riesgo al paciente y al profesional de enfermería.(AU)

Humanos , Administración de la Seguridad/normas , Contención de Riesgos Biológicos/enfermería , Prevención de Enfermedades , Equipo de Protección Personal , Unidades de Cuidados Intensivos , Indicadores de Calidad de la Atención de Salud , Atención de Enfermería/normas
Soc Work Health Care ; 60(1): 8-29, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1117682


The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers' roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic's impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.

/epidemiología , Servicio Social/organización & administración , Trabajadores Sociales/psicología , Grupos Focales , Procesos de Grupo , Humanos , Relaciones Interprofesionales , Salud Laboral , Pandemias , Grupo de Atención al Paciente/organización & administración , Rol Profesional , Investigación Cualitativa , Administración de la Seguridad/organización & administración , Servicio Social/normas , Factores Socioeconómicos , Telemedicina/organización & administración , Estados Unidos/epidemiología
Adv Clin Exp Med ; 30(2): 119-125, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1106613


The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue­matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.

/prevención & control , Atención Odontológica/organización & administración , Control de Infecciones/normas , Terapia por Láser/normas , Administración de la Seguridad/métodos , /transmisión , Atención Odontológica/métodos , Odontología , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Equipo de Protección Personal , Guías de Práctica Clínica como Asunto
Scand J Trauma Resusc Emerg Med ; 29(1): 41, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1105726


BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) outbreak in the Netherlands, the demand for intensive care beds exceeded availability within days. Initially, patients were redistributed regionally by ground transport. When transport over longer distances became necessary, we initiated a new Helicopter Emergency Medical Service (HEMS) operation. We hypothesize that the transport of contagious COVID-19 patients is feasible and safe for patients and HEMS personnel. METHODS: In this retrospective, single-centre observational study, flight and monitor data were used to calculate the exposure time of the retrieval team to COVID-19 patients. All the crew members (n = 18) were instructed on the proper use of personal protective equipment (PPE), dressing and undressing routine using buddy check supervision and cleaning procedures. All the team members were monitored for possible COVID-19 symptoms, as advised by our National Institute for Health and Environment. One month after completing the aeromedical transport all crew members were asked to donate a blood sample which was examined for the presence of IgG antibodies to SARS-CoV-2. RESULTS: From March 24 to May 25, 2020 the HEMS team transported 67 ventilated critical care COVID-19 patients. The exposure time was 7451 min (124 h and 11 min). One HEMS member reported pneumonia 6 weeks before the start of the patient transport. He tested positive for IgG SARS-CoV-2 by serology testing. We speculate that he was infected before the start of the operation; irrefutable evidence is lacking to support this claim because we did not perform serology testing before this operation started. CONCLUSION: Occupational COVID-19 exposure during helicopter transport of ventilated critical care COVID-19 patients can be performed safely when proper PPE is applied.

Ambulancias Aéreas , Aeronaves , Cuidados Críticos , Servicios Médicos de Urgencia , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Equipo de Protección Personal , Estudios Retrospectivos , Administración de la Seguridad/organización & administración
J Forensic Leg Med ; 78: 102123, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-1065321


The dental profession is considered at high potential risk of exposure and transmission of SARS-Cov-2. Thus, dentists should implement special safety measures in order to prevent any possible contamination during dental sessions and should be aware of the legal implications of their act in order to avoid malpractice leading them to be a causative agent of transmission of this virus. This paper aimed to provide a global review on COVID-19 preventive recommendations at dental clinics and discussed the legal values of such procedures, the dentist criminal and civil liability arising from transmitting this virus to a patient, the obligation of care under COVID-19 and the possible solution to this dilemma. The review concluded that dentists should follow all modern scientific procedures which are in their interest and in the interest of patients to maintain their safety and advised dentists to document all steps taken during the period of COVID-19 outbreak, because any undocumented action is considered not to have taken place, and they shall be bound by the burden of proof.

/prevención & control , Odontólogos/legislación & jurisprudencia , Responsabilidad Legal , Pautas de la Práctica en Odontología/legislación & jurisprudencia , Administración de la Seguridad/normas , Nivel de Atención/legislación & jurisprudencia , Clínicas Odontológicas , Humanos , Mala Praxis/legislación & jurisprudencia
Front Public Health ; 8: 625664, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1058477


Introduction: Safety behaviors are key elements in reducing the spread of the COVID-19 virus, but have also assumed excessive proportions in form of panic buying groceries. This raises the question whether these behaviors are independent or related to each other. Adherent safety behavior including increased hygiene and physical distancing appears inherently adherent and prosocial, while dysfunctional safety behavior such as panic buying most probably emerges from other motives and contextual variables. Methods: Data from 15,308 participants collected from March 10 to May 4, 2020, during the COVID-19 acute period in Germany, was analyzed to assess whether adherent and dysfunctional safety behavior are predicted by the same or divergent variables. Two multiple regression models are presented including various sociodemographic, trait, attitudinal, and COVID-19-specific variables as predictors. Results: Some variables similarly predict both, adherent and dysfunctional safety behavior. Yet, adherent safety behavior is stronger predicted by COVID-19-related fear than generalized anxiety, while a trend toward a reverse pattern emerged for dysfunctional safety behavior. Adherent safety behavior was also related to higher trust in governmental actions to face COVID-19, subjective level of information, as well as use of public media and TV to remain informed on COVID-19. Higher age was related to dysfunctional, but not adherent safety behavior. Respondents living in rural communities report more adherent safety behavior than urban dwellers. Discussion: Divergent psychological variables underlie adherent and dysfunctional safety behavior. This hints toward a theoretical separation with practical relevance in behavioral engineering and public health campaigning.

/epidemiología , /psicología , Conductas Relacionadas con la Salud , Pandemias/prevención & control , Medicina Preventiva/estadística & datos numéricos , Administración de la Seguridad/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Femenino , Alemania/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad
Otolaryngol Clin North Am ; 53(6): 1159-1170, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-1027957
Eur J Clin Invest ; 51(3): e13490, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1020570


BACKGROUND: There is an ongoing debate on a potential protective role of habitual physical activity and passive heat therapy on the risk of COVID-19, a respiratory infectious disease that can manifest as severe pneumonia. To explore these putative roles, we evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) with pneumonia risk in a prospective cohort study of 2275 men aged 42-61 years at recruitment. MATERIAL AND METHODS: Objectively measured CRF and self-reported sauna bathing habits were assessed at baseline. CRF was categorized as low and high (median cut-offs) and FSB as low and high (defined as ≤1 and 2-7 sessions/wk, respectively). Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident pneumonia. RESULTS: During a median follow-up of 26.6 years, 529 cases of pneumonia occurred. Comparing high vs low CRF, the multivariable-adjusted HR (95% CIs) for pneumonia was 0.75 (0.61-0.91). Comparing high vs low FSB, the corresponding HR was 0.81 (0.68-0.97). Compared to men with low CRF & low FSB, the multivariable-adjusted HRs of pneumonia for the following groups: high CRF & low FSB; low CRF & high FSB; and high CRF & high FSB were 0.88 (0.65-1.20), 0.89 (0.71-1.13), and 0.62 (0.48-0.80) respectively. CONCLUSIONS: In a general male Caucasian population, a combination of high fitness levels and frequent sauna baths is associated with a substantially lowered future pneumonia risk compared with each modality alone. The implications of these findings in altering COVID-19 disease or its severity deserve study.

Capacidad Cardiovascular , Neumonía/epidemiología , Baño de Vapor/estadística & datos numéricos , /epidemiología , Estudios de Cohortes , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Administración de la Seguridad
Air Med J ; 40(2): 112-114, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1002267


OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the frequent transfer of critically ill patients, yet there is little information available to assist critical care transport programs in protecting their clinicians from disease exposure in this unique environment. The Lifeline Critical Care Transport Program has implemented several novel interventions to reduce the risk of staff exposure. METHODS: Several safety interventions were implemented at the beginning of the COVID-19 pandemic. These initiatives included the deployment of a transport safety officer, a receiving clean team for select interfacility transports, and modifications in personal protective equipment. RESULTS: From February 29, 2020, to August 29, 2020, there were 1,041 transports of persons under investigation, 660 (63.4%) of whom were ultimately found to be COVID-19 positive. Approximately one third were ground transports, 11 (1.1%) were by air, and the remainder were intrahospital transports. There were 0 documented staff exposures or illnesses during the study period. CONCLUSION: The adaptation of these safety measures resulted in 0 staff exposures or illnesses while maintaining a high-volume, high-acuity critical care transport program. These interventions are the first of their kind to be implemented during the COVID-19 pandemic and offer a framework for other organizations and future disease outbreaks.

/prevención & control , Control de Enfermedades Transmisibles/métodos , Servicios Médicos de Urgencia , Pandemias , Administración de la Seguridad/normas , Transporte de Pacientes , Baltimore/epidemiología , Cuidados Críticos , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Administración de la Seguridad/métodos , Transporte de Pacientes/organización & administración
Air Med J ; 40(2): 130-134, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1002266


The coronavirus disease 2019 pandemic disrupted health care delivery in every respect, including critical care resources and the transport of patients requiring extracorporeal membrane oxygenation. Innovative solutions allowing for safe helicopter air transport of these critical patients is needed because extracorporeal membrane oxygenation resources are only available in specialty centers. We present a case demonstrating the interfacility collaboration of care for a patient with coronavirus disease 2019 infection and the lessons learned from the air transport. Careful planning, coordination, communication, and teamwork contributed to the safe transport of this patient and several others subsequently.

Ambulancias Aéreas , Control de Enfermedades Transmisibles/organización & administración , Cuidados Críticos , Oxigenación por Membrana Extracorpórea , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Adulto , Conducta Cooperativa , Humanos , Masculino , Administración de la Seguridad
S Afr Med J ; 0(0): 13182, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: covidwho-984482


BACKGROUND: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS: A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS: Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS: The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.

Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Control de Infecciones , Servicio de Cirugía en Hospital , Atención Terciaria de Salud , Adulto , /prevención & control , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Política de Salud , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Masculino , Mortalidad , Evaluación de Necesidades , Innovación Organizacional , Administración de la Seguridad/tendencias , Sudáfrica/epidemiología , Servicio de Cirugía en Hospital/organización & administración , Servicio de Cirugía en Hospital/estadística & datos numéricos , Atención Terciaria de Salud/organización & administración , Atención Terciaria de Salud/tendencias
S Afr Med J ; 0(0): 13162, 2020 12 09.
Artículo en Inglés | MEDLINE | ID: covidwho-994170


BACKGROUND: Given the global shortage of N95 filtering facepiece respirators (FFP2 in Europe) during the COVID-19 pandemic, KN95 masks (Chinese equivalent of the N95 and FFP2) were imported and distributed in South Africa (SA). However, there are hardly any published independent safety data on KN95 masks. OBJECTIVES: To evaluate the seal, fit and filtration efficiency of several brands of KN95 masks marketed for widespread use in SA healthcare facilities, using standardised testing protocols. METHODS: The verifiability of manufacturer and technical details was first ascertained, followed by evaluation of the number of layers comprising the mask material. The testing protocol involved a directly observed positive and negative pressure user seal check, which if passed was followed by qualitative fit testing (sodium saccharin) in healthy laboratory or healthcare workers. Quantitative fit testing (3M) was used to validate the qualitative fit testing method. The filtration efficacy and integrity of the mask filter material were evaluated using a particle counter-based testing rig utilising aerosolised saline (expressed as filtration efficacy of 0.3 µm particles). Halyard FLUIDSHIELD 3 N95 and 3M 1860 N95 masks were used as controls. RESULTS: Twelve KN95 mask brands (total of 36 masks) were evaluated in 7 participants. The mask type and manufacturing details were printed on only 2/12 brands (17%) as per National Institute of Occupational Safety and Health and European Union regulatory requirements. There was considerable variability in the number of KN95 mask layers (between 3 and 6 layers in the 12 brands evaluated). The seal check pass rate was significantly lower in KN95 compared with N95 masks (1/36 (3%) v. 12/12 (100%); p<0.0001). Modification of the KN95 ear-loop tension using head straps or staples, or improving the facial seal using Micropore 3M tape, enhanced seal test performance in 15/36 KN95 masks evaluated (42%). However, none of these 15 passed downstream qualitative fit testing compared with the control N95 masks (0/15 v. 12/12; p<0.0001). Only 4/8 (50%) of the KN95 brands tested passed the minimum filtration requirements for an N95 mask (suboptimal KN95 filtration efficacy varied from 12% to 78%, compared with 56% for a surgical mask and >99% for the N95 masks at the 0.3 µm particle size). CONCLUSIONS: The KN95 masks tested failed the stipulated safety thresholds associated with protection of healthcare workers against airborne pathogens such as SARS-CoV-2. These preliminary data have implications for the regulation of masks and their distribution to healthcare workers and facilities in SA.

Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Ensayo de Materiales/métodos , Exposición Profesional/prevención & control , /epidemiología , Diseño de Equipo/métodos , Diseño de Equipo/normas , Análisis de Falla de Equipo , Humanos , Administración de la Seguridad/organización & administración , Sudáfrica/epidemiología