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1.
J Clin Anesth ; 86: 111057, 2023 06.
Article in English | MEDLINE | ID: mdl-36696834

ABSTRACT

INTRODUCTION: The global COVID-19 pandemic highlighted the importance of protecting frontline healthcare workers from novel respiratory infections while also exposing the limited instruction that medical students receive on proper donning of personal protective equipment (PPE) and more importantly the safe doffing of contaminated PPE to minimize their risk of nosocomial infection. The best methods of providing this kind of instruction have not yet been determined. METHODS: Anesthesiology interns and CA-1 residents were trained on proper PPE donning and doffing for AGPs using a methodology based on Miller's pyramid and following a "knows-knows how-shows-does" progression. Participants donned PPE without instruction and were sprayed with Glo Germ® to identify areas of contamination, after which they received both video and in-person instruction on best practices for donning and doffing PPE for AGPs. Following instruction, they again donned PPE and were sprayed with Glo Germ® to identify areas of contamination. RESULTS: 54 participants completed the study. Before training, overall donning compliance was 60% and overall doffing compliance was 48%. Overall, 70% were contaminated after PPE doffing, with 46% having multiple sites of contamination. After training, donning compliance increased by nearly 30% (P < 0.001), doffing compliance increased by over 20% (P < 0.001), and overall contamination decreased by nearly 30% (P = 0.029), with multiple-site contamination decreasing to only 6% (P = 0.013). DISCUSSION: While best methods for providing instruction regarding topics such as PPE donning and doffing have not yet been determined, we have demonstrated that the underlying knowledge base from medical school regarding proper donning and doffing for respiratory isolation is insufficient for preventing self-contamination, and that Miller's pyramid-based training using both video and in-person instruction combined with task execution by learners can improve compliance with PPE donning and doffing protocols and more importantly decrease skin contamination among a group of early training anesthesiology residents.


Subject(s)
COVID-19 , Cross Infection , Humans , COVID-19/prevention & control , Pandemics/prevention & control , Personal Protective Equipment , Infection Control/methods , Health Personnel
2.
Arch. méd. Camaguey ; 25(2): e8018, mar.-abr. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1248835

ABSTRACT

RESUMEN Fundamento: el virus SARS-CoV-2 es responsable de la segunda pandemia del siglo XXI. Desde su aparición en China a finales de 2019, se asocia a neumonía y considera como un virus respiratorio más. Sin embargo, durante su diseminación global demuestra su capacidad para producir daño a otros órganos con manifestaciones clínicas nunca antes descritas para otros virus respiratorios. Objetivo: describir la evidencia científica que respalde el daño extrapulmonar directo producido por el virus SARS-CoV-2 en etapas tardías de la infección, que apoyan su naturaleza bifásica y distinta frente a otros virus respiratorios. Métodos: se realizó una búsqueda de artículos referente al tema en las bases de datos MEDLINE accedido desde PubMed, SciELO y LILACS. También se tuvieron en cuenta artículos publicados en los repositorios de preimpresión como medRxiv, BioRxiv. Mediante el gestor de búsqueda y administrador de referencias Mendeley, se eliminaron los duplicados y aquellos que no se ajustaban al objetivo del estudio, se seleccionaron 63 artículos para la revisión. Resultados: la evidencia sugiere que el SARS-CoV-2 tiene tropismo no solo limitado a las vías respiratorias. La progresión clínica de la COVID-19 presenta un curso bifásico, con manifestaciones de tipo gripal en la primera fase y episodios postagudos y persistentes en la fase tardía, ocasionados por el daño directo al sistema nervioso central, cardiovascular, endocrino y renal. Conclusiones: la infección por SARS-CoV-2 no debe considerarse solo como una infección aguda y circunscrita a las vías respiratorias.


ABSTRACT Background: the SARS-CoV-2 virus is responsible for the second pandemic of the 21st century. Since its appearance in China at the end of 2019, it has been associated with pneumonia and considered to be just another respiratory virus. However, during its global spread, it shows its ability to damage other organs with clinical manifestations never before described for other respiratory viruses. Objective: to describe the scientific evidence that supports the direct extra-pulmonary damage produced by the SARS-CoV-2 virus in late stages of infection, which supports its biphasic nature and different from other respiratory viruses. Methods: a search of the articles was carried out in the MEDLINE databases accessed from PubMed, SciELO and LILACS. Articles published in prepress repositories such as medRxiv, BioRxiv were also taken into account. Using the Mendeley reference manager and search manager, duplicates and those that did not meet the objective of the study were eliminated, selecting 63 articles for the present review. Results: the evidence suggests that SARS-CoV-2 has a tropism not only limited to the respiratory tract. The clinical progression of COVID-19 presents a biphasic course, with flu-like manifestations in the first phase and post-acute and persistent episodes in the late phase, caused by direct damage to the central nervous, cardiovascular, endocrine and renal systems. Conclusions: SARS-CoV-2 infection should not be considered only as an acute infection limited to the respiratory tract.

3.
Arch. méd. Camaguey ; 24(6): e7616, oct.-dic. 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1152910

ABSTRACT

RESUMEN Fundamento: debido a las características de la infección con SARSCoV-2, la cavidad bucal es un entorno que representa un alto riesgo para producir infección cruzada entre los pacientes y los odontólogos. Objetivo: recopilar la evidencia científica sobre si la cavidad bucal es una fuente de transmisión del SARSCoV-2. Métodos: se realizó una revisión en PubMed/Medline y Cochrane mediante términos de indización, para obtener información si la cavidad bucal es una fuente de transmisión del SARSCoV-2. Resultados: debido al contacto cercano con la boca y la nariz del paciente, las gotas y los aerosoles producidos en el tratamiento bucal exponen al odontólogo a infectarse con SARSCoV-2. Al analizar la información bibliográfica se encuentra evidencia de que el SARSCoV-2 se une de forma inicial a la enzima convertidora de angiotensina II que se encuentra en la mucosa oral, la lengua y las glándulas salivales, para después recién colonizar los tractos respiratorios; por lo que, se puede considerar a la cavidad bucal como una fuente de contagio y además la saliva puede usarse para realizar el análisis molecular del SARSCoV-2. Conclusiones: la evidencia científica recopilada, sugiere que la cavidad bucal puede actuar como una fuente de contagio del SARSCoV-2, gracias a la presencia en la boca de la enzima convertidora de angiotensina II que actúa como receptor del SARSCoV-2 y convierte a esta cavidad en una fuente de transmisión.


ABSTRACT Background: due to the characteristics of SARSCoV-2 infection, the oral cavity is a high risk environment for cross-infection between patients and dentists. Objective: to gather scientific evidence on whether the oral cavity is a source of SARSCoV-2 transmission. Methods: a review was performed in PubMed / Medline and Cochrane using indexing terms, to obtain information if the oral cavity is a source of SARSCoV-2 transmission. Results: due to close contact with the patient's mouth and nose, the drops and aerosols produced in the oral treatment expose the dentist to becoming infected with SARSCoV-2. Analyzing the bibliographic information, we find evidence that SARSCoV-2 binds initially to the angiotensin II converting enzyme found in the oral mucosa, tongue and salivary glands, and then only recently colonized the respiratory tracts; therefore, the oral cavity can be considered as a source of contagion and saliva can also be used to perform the molecular analysis of SARSCoV-2. Conclusions: the collected scientific evidence suggests that the oral cavity may act as a source of SARSCoV-2 transmission, thanks to the presence in the mouth of the angiotensin II converting enzyme that acts as a receptor for SARSCoV-2 and converts this cavity into a source of transmission.

4.
Arch. méd. Camaguey ; 24(5): e7645, tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1131161

ABSTRACT

RESUMEN Fundamento: la falta de referencias a crisis semejantes a la pandemia COVID-19 en el pasado hace difícil poder predecir qué pueda suceder en el futuro inmediato. Lógicamente, los efectos presentes son fáciles y documentables, pero aquellos que dejarán huella en los distintos actores a medio y a largo plazo resultan más sujetos a debate. Objetivo: analizar el comportamiento de esta pandemia en la región cubana centrado en el mes de abril, al mostrar la mejor dirección a seguir a la hora de la toma de decisiones. Métodos: se diseñó un modelo matemático en función del impacto de la efectividad de las medidas ante esta pandemia basada en las funciones polinómicas de casos confirmados y los casos recuperados en el territorio durante el mes de abril. Resultados: se tiene el comportamiento actual y futuro de la efectividad del tratamiento ante esta pandemia al permitir tomar decisiones a corto y largo plazo atendiendo a estas variables. Conclusiones: se obtuvo la función de efectividad basado en las funciones de casos confirmados y casos recuperados diarios, al evidenciar que se pronostica mejoras en el enfrentamiento de la pandemia con extrema disciplina. Lo que permite al territorio establecer una estrategia de mejora basadas en un plan de acción.


ABSTRACT Background: the lack of references to crises similar to COVID-19 pandemic in the past makes difficult to predict what may happen in the immediate future. Logically, the present effects are easily documented, but those that will leave their mark on the different actors in the medium and long term are subject to more debate. Objective: to analyze the behavior of this pandemic in the Cuban region centered on the month of April, showing the best direction to follow when making decisions. Methods: a mathematical model was designed based on the impact of the effectiveness of the measures in the face of this pandemic based on the polynomial functions of confirmed cases and the cases recovered in the territory during the month of April. Results: the current and future behavior of the effectiveness of the treatment in the face of this pandemic is showed, allowing decisions to be made in the short and long term, taking into account these variables. Conclusions: the effectiveness function was obtained based on the functions of confirmed cases and daily recovered cases, showing that improvements are expected in the confrontation of the pandemic with extreme discipline, which allows the territory to establish an improvement strategy based on an action plan.

5.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1177679

ABSTRACT

Introducción: La evolución de la pandemia del COVID-19 varía en cada población; complicando los sistemas de salud a nivel mundial. Objetivo: analizar la evolución de la pandemia Covid-19 estimando el efecto de las medidas de contención realizadas en Perú. Material y Métodos: Se aplicó el modelamiento matemático epidemiológico SIR, estimando la evolución COVID-19 en nuestra población. Se realizó el análisis de datos siguiendo el modelo matemático SIR con ecuaciones diferenciales ordinarias definidas para simular el comportamiento epidemiológico; y fue ejecutado en el lenguaje de programación RStudio. Resultados: En el estudio las medidas de contención disminuyeron la tasa de propagación, redujeron el 30% de casos infectados hasta el día pico de infección; sin embargo, ésta aún se encuentra por encima del número reproductivo efectivo para control de la epidemia y presenta una tendencia errática, el resultado de las acciones gubernamentales es del 61% en la práctica de medidas de contención. Conclusiones: Las medidas de contención son necesarias; siempre que, se consideren estrategias que permitan hacer efectivo su rol en nuestra población


Introduction: The evolution of the COVID-19 pandemic varies in each population; it has been complicating health systems worldwide. Objective: to analyze the evolution of the Covid-19 pandemic, estimating the effect of the containment measures practiced in Peru. Material and Method: The SIR epidemiological mathematical modeling was applied, estimating the COVID-19 evolution in our population. Data analysis was performed following the SIR mathematical model with defined ordinary differential equations to simulate epidemiological behavior; and it was executed in the RStudio programming language. Results: Containment measures decreased the propagation rate, reducing 30% of infected cases until the peak day of infection; however, it is still above the effective reproductive number to control the epidemic and it shows an erratic trend, the result of government actions being 61% in the practice of containment measures. Conclusions: Containment measures are necessary if strategies are considered to make their role effective in our population.

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