Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse / Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes. MATERIAL Y MÉTODOS: Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España. RESULTADOS: Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana. CONCLUSIÓN: En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. / Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse.

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.

Should policy-makers and managers trust PSI? An empirical validation study of five patient safety indicators in a national health service.

BACKGROUND: Patient Safety Indicators (PSI) are being modestly used in Spain, somewhat due to concerns on their empirical properties. This paper provides evidence by answering three questions: a) Are PSI differences across hospitals systematic -rather than random?; b) Do PSI measure differences among hospital-providers -as opposed to differences among patients?; and, c) Are measurements able to detect hospitals with a higher than "expected" number of cases? METHODS: An empirical validation study on administrative data was carried out. All 2005 and 2006 publicly-funded hospital discharges were used to retrieve eligible cases of five PSI: Death in low-mortality DRGs (MLM); decubitus ulcer (DU); postoperative pulmonary embolism or deep-vein thrombosis (PE-DVT); catheter-related infections (CRI), and postoperative sepsis (PS). Empirical Bayes statistic (EB) was used to estimate whether the variation was systematic; logistic-multilevel modelling determined what proportion of the variation was explained by the hospital; and, shrunken residuals, as provided by multilevel modelling, were plotted to flag hospitals performing worse than expected. RESULTS: Variation across hospitals was observed to be systematic in all indicators, with EB values ranging from 0.19 (CI95%:0.12 to 0.28) in PE-DVT to 0.34 (CI95%:0.25 to 0.45) in DU. A significant proportion of the variance was explained by the hospital, once patient case-mix was adjusted: from a 6% in MLM (CI95%:3% to 11%) to a 24% (CI95%:20% to 30%) in CRI. All PSI were able to flag hospitals with rates over the expected, although this capacity decreased when the largest hospitals were analysed. CONCLUSION: Five PSI showed reasonable empirical properties to screen healthcare performance in Spanish hospitals, particularly in the largest ones.