PPE

PPE
  • 文章类型: Journal Article
    2019年冠状病毒病(COVID-19)大流行,由严重急性呼吸综合征冠状病毒-2(SARS-CoV-2)引起,遍布180多个国家,导致世界各地多样化的卫生系统过载。由于患者人数众多和供应链中断,它导致了医疗设备和个人防护设备的短缺。在这种情况下,来自增材制造界的倡议出现了,以对抗设备的缺乏。生产了各种设计,目前患者和卫生工作者正在医院中使用。然而,由于某些设备必须遵循严格的标准,这些产品可能不符合这些标准。因此,为了确保用户的健康,需要了解每个设备,他们的用法,和标准。这项研究回顾了在COVID-19大流行期间增材制造的使用。它收集了几种3D打印设备的来源,如面罩,口罩,阀门,鼻咽拭子,和其他人,讨论它们的使用和监管问题。在这方面,该技术的主要缺点,为下一个大流行场景处理,被突出显示。最后,给出并讨论了在紧急情况下增材制造的未来的一些见解。
    The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread through more than 180 countries, leading to diverse health systems overload around the world. Because of the high number of patients and the supply chain disruption, it generated a shortage of medical devices and personal protective equipment. In this context, initiatives from the additive manufacturing community emerged to fight the lack of devices. Diverse designs were produced and are currently being used in hospitals by patients and health workers. However, as some devices must follow strict standards, these products may not fulfill these standards. Therefore, to ensure the user\'s health, there is a need for understanding each device, their usage, and standards. This study reviews the use of additive manufacturing during COVID-19 pandemic. It gathers the source of several 3D printed devices such as face shields, face masks, valves, nasopharyngeal swabs, and others, discussing their use and regulatory issues. In this regard, the major drawbacks of the technology, addressed for the next pandemic scenario, are highlighted. Finally, some insights of the future of additive manufacturing during emergency are given and discussed.
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  • 文章类型: Journal Article
    新型冠状病毒,COVID-19造成了一场具有显著死亡率和发病率的大流行,给患者和医护人员带来了挑战。COVID-19的全球传播导致个人防护设备(PPE)短缺,使前线卫生工作者得不到保护,并使医疗保健系统不堪重负。3D打印非常适合解决口罩短缺的问题。脸盾,测试套件和呼吸机。在这篇文章中,我们回顾了3D打印,并提出了为治疗COVID-19患者的医护人员创建PPE的潜在应用。使用PubMed进行了全面的文献综述,关键词为“冠状病毒病2019”,“COVID-19”,“严重急性呼吸综合征冠状病毒2”,“SARS-CoV-2”,“供应短缺”,“N95呼吸器面罩”,“个人防护装备”,\"PPE\",\"呼吸机\",\"三维模型\",\"三维打印\"\"3D打印\"和\"呼吸机\"。总结了与COVID-193D打印临床应用开发相关的重要研究。3D技术具有通过可访问性彻底改变医疗保健的巨大潜力,负担得起和个性化。
    The novel coronavirus, COVID-19, created a pandemic with significant mortality and morbidity which poses challenges for patients and healthcare workers. The global spread of COVID-19 has resulted in shortages of personal protective equipment (PPE) leaving frontline health workers unprotected and overwhelming the healthcare system. 3D printing is well suited to address shortages of masks, face shields, testing kits and ventilators. In this article, we review 3D printing and suggest potential applications for creating PPE for healthcare workers treating COVID-19 patients. A comprehensive literature review was conducted using PubMed with keywords \"Coronavirus disease 2019\", \"COVID-19\", \"severe acute respiratory syndrome coronavirus 2\", \"SARS-CoV-2\", \"supply shortages\", \"N95 respirator masks\", \"personal protective equipment\", \"PPE\", \"ventilators\", \"three-dimensional model\", \"three-dimensional printing\" \"3D printing\" and \"ventilator\". A summary of important studies relevant to the development of 3D-printed clinical applications for COVID-19 is presented. 3D technology has great potential to revolutionize healthcare through accessibility, affordably and personalization.
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  • 文章类型: Systematic Review
    最近几个国家矽肺病病例的增加使人们对粉尘控制实践及其在预防可吸入结晶二氧化硅(RCS)暴露方面的有效性产生了怀疑。除了矽肺病,RCS可能会导致其他疾病,工人及其家人与健康相关的生活质量损失,和企业的经济损失。因此,本系统文献综述研究了预防RCS暴露和增加粉尘控制措施使用的干预措施的有效性.该评论使用与粉尘控制干预措施相关的关键字来搜索七个数据库。筛选并提取搜索结果用于合成。叙事综合显示了中国的研究投入程度。在几种设计和组合中,干预措施利用了水,表面活性剂,泡沫,和气流以减少灰尘暴露。这些干预措施对RCS和可吸入粉尘提供了不同程度的粉尘控制效果。尽管有证据表明干预措施显着降低了粉尘浓度水平,适当的控制措施可能无法有效防止工作场所过度暴露于RCS。审查发现,采用教育和培训干预措施来改善粉尘控制和呼吸防护设备(RPE)的使用。此外,营销策略促进RPE的使用。这些干预措施可以增加RPE的使用频率和最佳实践粉尘控制措施的采用。干预增加知识,意识,以及对RPE使用的态度,并在减少误解的同时产生积极的看法。然而,干预措施实施后,从干预措施中获得的好处可能会减少,表明干预措施可能不会持续激励工人采取控制措施或使用RPE。
    The recent increase in silicosis cases in several countries casts doubt on dust control practices and their effectiveness in preventing respirable crystalline silica (RCS) exposure. Apart from silicosis, RCS may lead to other illnesses, health-related quality of life losses for workers and their families, and economic losses for companies. Thus, this systematic literature review examined the effectiveness of interventions employed to prevent exposure to RCS and increase the use of dust control measures. The review used keywords related to dust control interventions to search seven databases. Search results were screened and extracted for synthesis. The narrative synthesis showed the extent of research investment in China. In several designs and combinations, the interventions utilized water, surfactant, foam, and air currents to reduce dust exposure. These interventions offer varying degrees of dust control effectiveness against RCS and respirable dust. Although evidence indicates that interventions significantly decrease dust concentration levels, the control measures in place may not effectively prevent workplace overexposure to RCS. The review found that education and training interventions are employed to improve dust controls and respiratory protective equipment (RPE) use. Also, marketing strategies promote the use of RPE. These interventions can increase the frequency of use of RPE and the adoption of best practice dust control measures. Interventions increase knowledge, awareness, and attitudes about RPE usage and generate positive perceptions while reducing misconceptions. However, the benefits obtained from an intervention may diminish after its implementation, indicating that the interventions may not continually motivate workers to adopt control measures or use RPE.
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  • 文章类型: Systematic Review
    During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.
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  • 文章类型: Journal Article
    冠状病毒(COVID-19)全球大流行导致负责向医院提供基本设备以及为卫生和社会护理人员提供个人防护设备(PPE)的传统供应链崩溃。三维(3D)打印社区通过识别整个医疗保健系统的短缺并实时提供创新解决方案来响应新兴需求。规避短期全球供应问题。根据使用MEDLINE的系统评价和荟萃分析(PRISMA)指南的首选报告项目,进行了系统评价,以调查3D打印在COVID-19大流行中的作用。EMBASE,和世界卫生组织(WHO)COVID-19数据库。使用NEXIS媒体数据库确定了报纸和互联网文章来源。所有关于在COVID-19大流行高峰期3D打印解决方案应用的研究和文章都包括在内。文献检索确定了26篇相关文章,13项研究符合纳入标准,适合全文回顾.识别出一千二百零一篇独特的数字媒体文章;在删除重复项并筛选标题以纳入和排除标准之后,460篇文章适合全文复习。3D打印社区和医疗保健系统之间的交叉合作有助于提供创新的解决方案来应对COVID-19危机。3D打印的应用范围从充氧设备到非侵入性和侵入性通气部分,以及用于感染控制和检疫中心的创新解决方案。这次审查发现,3D打印技术对PPE的生产做出了最大的贡献,特别是面罩。反映最短缺和最需要的领域。增材制造在调整工程学科方面发挥了关键作用,科学,和更大利益的药物。我们目睹了传统供应链的快速重组,以规避全球短缺,同时在努力限制这次和未来大流行的影响方面取得了进展。
    The coronavirus (COVID-19) global pandemic resulted in the breakdown of traditional supply chains responsible for providing essential equipment to hospitals and personal protective equipment (PPE) for health and social care workers. The three-dimensional (3D) printing community has responded to emerging need by recognizing shortages across health care systems and providing innovative solutions in real time, circumventing short-term global supply issues. A systematic review was undertaken to investigate the role of 3D printing in the COVID-19 pandemic in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and World Health Organization (WHO) COVID-19 databases. Newspaper and internet article sources were identified using the NEXIS media database. All studies and articles on the application of 3D printed solutions during the peak of the COVID-19 pandemic were included. The literature search identified 26 related articles, and 13 studies met inclusion criteria and were suitable for full-text review. One thousand two hundred and one unique digital media articles were identified; after removal of duplicates and screening of headlines for the inclusion and exclusion criteria, 460 articles were suitable for full-text review. The cross-collaboration between the 3D printing community and health care systems has aided in the provision of innovative solutions to combat the COVID-19 crisis. The applications for 3D printing ranged from oxygenation equipment to noninvasive and invasive ventilatory parts and innovative solutions for infection control and quarantine hubs. This review has identified that 3D printing technology has made the biggest contribution to the production of PPE in particular face shields, mirroring the areas of greatest shortage and need. Additive manufacturing has played a pivotal role in aligning disciplines in engineering, science, and medicine for the greater good. We have witnessed the rapid reconfiguration of traditional supply chains to circumvent global shortages, while making advancements in effort to limit the impact of this and future pandemics.
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    文章类型: Journal Article
    COVID-19大流行直接或间接影响了世界各地数百万人。死亡被认为是COVID-19的潜在死亡原因或促成死亡原因。据估计,在2020年和2021年,数百万人的超额死亡与COVID-19大流行有关。对COVID-19尸体进行临床尸检的重要性在于更好地了解疾病的发病机制。此外,如果出于医学法律目的,可以对感染COVID-19的尸体进行法医尸检。从尸检的角度来看,处理COVID-19感染的尸体需要遵循具体的指导方针和安全措施,以限制SARS-CoV-2的传播。这是至关重要的,因为COVID-19是一种由新发现的病毒引起的新兴传染病。这篇评论叙述了在处理COVID-19尸体的不同阶段应遵循的安全措施,从死亡现场开始到葬礼。本评论还简要介绍了处理COVID-19尸体的伦理问题。由于COVID-19可以通过受感染的身体传播,穿戴推荐的个人防护装备至关重要,专门用于气溶胶生成程序。在将尸体运送到太平间之前,需要考虑具体的安全措施,有特殊要求要在那里执行,例如特定的工程控制,员工培训,和尸检室预防措施。在进行尸检后,工具和设备的消毒,尸体袋,运输车辆,尸检室也应该考虑.
    The COVID-19 pandemic has affected millions of people around the world either directly or indirectly. Deaths have been attributed to COVID-19 as the underlying cause of death or as a contributing cause of death. It is estimated that millions of excess deaths were associated with the COVID-19 pandemic in 2020 and 2021. The importance of a clinical autopsy on COVID-19 corpses lies in understanding the pathogenesis of the disease better. Moreover, a forensic autopsy may be performed on a COVID-19-infected corpse when indicated for medico-legal purposes. From the autopsy perspective, handling COVID-19-infected corpses requires specific guidelines and safety measures to be followed to limit the transmission of SARS-CoV-2, the causative virus. This is essential as COVID-19 is an emerging infectious disease caused by a newly discovered virus. This review narrates the safety measures that should be followed at different stages of handling COVID-19 corpses, starting from the death scene to burial and funeral. Ethical issues in handling COVID-19 corpses are also briefed in this review. As COVID-19 can be transmitted through infected bodies, it is crucial to wear recommended personal protective equipment, specifically for aerosol-generating procedures. There are specific safety measures to be considered before transporting the body to the mortuary, with particular requirements to be implemented there, such as specific engineering controls, staff training, and autopsy room precautions. After conducting the autopsy, disinfection of the tools and equipment, body bags, transport vehicles, and the autopsy room should be considered.
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  • 文章类型: Journal Article
    背景:现在已经广泛认识到,医疗保健人员(HCP)在个人防护设备(PPE)脱下过程中面临病原体污染的风险。对这种现象的研究,使用了各种PPE合奏,方法和实验方法。
    方法:进行了范围审查,与PRISMA指导一致。使用先验搜索策略搜索PubMed和sciVerseScopus数据库。使用矩阵方法提取数据进行分析,然后进行叙事分析。文章根据PPE集合进行分类。
    结果:151篇文章中只有19篇被纳入最终分析。所有纳入的研究都报告了一些脱落后的污染,这种污染最常出现在手上,手腕,脸和脖子经过审查的研究使用了各种示踪污染物,PPE合奏,doffing协议,示踪剂评估位置和方法,这使得很难识别跨研究的模式。
    UNASSIGNED:需要进行额外的研究,以改进与示踪剂的选择和放置有关的研究方法,以确保对落袋后污染的灵敏检测,比较特定的落纱程序或PPE片段如何影响落纱后污染,并了解脱毒后污染对患者和HCP感染风险意味着什么。
    It is now widely recognized that health care personnel (HCP) are at risk of contamination with pathogens during personal protective equipment (PPE) doffing. Studies of this phenonemona, have utilized a variety of PPE ensembles, doffing methods, and experimental methods.
    A scoping review was performed, consistent with PRISMA guidance. The PubMed and sciVerse Scopus databases were searched using an a priori search strategy. Data were extracted for analysis using the matrix method, and then a narrative analysis was performed. Articles were classified based on PPE ensemble.
    Only 19 of 151 articles were included in the final analysis. All included studies reported some post-doffing contamination, and this contamination was most frequently observed on the hands, wrist, face, and neck. Reviewed studies used a variety of tracer contaminants, PPE ensembles, doffing protocols, tracer assessment locations, and methods, making it difficult to identify patterns across studies.
    Additional research is needed to improve the study methodology related to the selection and placement of tracers to ensure sensitive detection of post-doffing contamination, compare how specific doffing procedures or pieces of PPE influence post-doffing contamination, and to understand what post-doffing contamination means for patient and HCP infection risk.
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  • 文章类型: Journal Article
    国际消防界积极参与以发展为重点的广泛活动,测试,并实施有效的方法来减少接触污染物和相关的癌症风险。然而,这些活动通常被视为彼此独立,并且没有更大的整体工作来减轻职业健康风险。这篇叙述性综述综合了在国家职业安全与健康研究所(NIOSH)控制层次背景下对消防污染控制的当前研究,一个框架,支持围绕在职业环境中实施可行和有效的控制解决方案的决策。使用这种方法,我们确定了基于证据的措施,这些措施已经过调查,可以在应急响应期间实施以保护消防员,在消防设备和消防站,并确定仍然存在的几个知识差距。尽管大量的研究和开发都集中在改善个人防护设备,以应对消防服务面临的各种风险,这些措施被认为不太有效。近年来,可以在交火期间和之后使用的行政和工程控制也受到了越来越多的研究兴趣。然而,较少的研究和开发集中在更高水平的控制措施上,如工程,替换,消除,这可能是最有效的,但实施起来很有挑战性。全面的方法,考虑每个级别的控制以及如何实施,考虑到需要平衡减少污染风险与拯救生命和保护财产的消防任务,可能是最有效的。
    The international fire service community is actively engaged in a wide range of activities focused on development, testing, and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independent of each other and in the absence of the larger overall effort of occupational health risk mitigation. This narrative review synthesizes the current research on fire service contamination control in the context of the National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls, a framework that supports decision making around implementing feasible and effective control solutions in occupational settings. Using this approach, we identify evidence-based measures that have been investigated and that can be implemented to protect firefighters during an emergency response, in the fire apparatus and at the fire station, and identify several knowledge gaps that remain. While a great deal of research and development has been focused on improving personal protective equipment for the various risks faced by the fire service, these measures are considered less effective. Administrative and engineering controls that can be used during and after the firefight have also received increased research interest in recent years. However, less research and development have been focused on higher level control measures such as engineering, substitution, and elimination, which may be the most effective, but are challenging to implement. A comprehensive approach that considers each level of control and how it can be implemented, and that is mindful of the need to balance contamination risk reduction against the fire service mission to save lives and protect property, is likely to be the most effective.
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  • 文章类型: Journal Article
    我们旨在概述工作环境和职业健康如何受到影响,并描述旨在改善流行病和大流行期间工作环境的干预措施。遵循系统评价和荟萃分析(PRISMA)的首选报告项目指南。Cinahl数据库,Medline,PsycInfo,搜索了WebofScience的人口:工作人口;暴露:冠状病毒流行或大流行;结果:工作环境,在2020年10月之前发表的文章中。质量评估基于改进版本的混合方法评估工具(MMAT)。重复数据删除后,仍有3711篇文章,其中530个被选择用于全文筛选,119个被选择用于质量评估。在排除低质量的研究之后,95只剩下其中85人专注于医疗保健人员,10人专注于其他行业的员工;73人使用定量方法,22人使用定性或混合方法;大多数基于横截面数据。医护人员经历了工作需求的增加,领导能力差,和缺乏资源(个人防护设备,人员,和能力)。对感染患者的高要求和工作与负面的心理健康结果有关。缺乏评估干预措施的研究,来自医疗保健以外行业的研究,和高质量的研究。
    We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.
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  • 文章类型: Journal Article
    目的:为了检查结果,证据水平,关于外科口罩在减少病毒性呼吸道疾病传播方面的有效性的原始研究的方法学质量,and,特别是,N95呼吸器与外科口罩的性能。
    方法:根据使用PubMed的系统评价和荟萃分析(PRISMA)指南的首选报告项目进行荟萃分析,MEDLINE,和Cochrane图书馆数据库.
    结果:在筛选153篇文章后,纳入了8项研究(9164名参与者)。分析显示,使用N95呼吸器与外科口罩预防流感样疾病的差异具有统计学意义(风险比[RR]=0.81,95%置信区间[CI]=0.68-0.94,P<0.05),非流感呼吸道病毒感染(RR=0.62,95%CI=0.52-0.74,P<0.05),呼吸道病毒感染(RR=0.73,95%CI=0.65-0.82,P<0.05),严重急性呼吸综合征冠状病毒(SARS-CoV)1和2病毒感染(RR=0.17,95%CI=0.06-0.49,P<0.05),和实验室确认的呼吸道病毒感染(RR=0.75,95%CI=0.66-0.84,P<0.05)。分析结果与实验室确诊的流感没有统计学意义(RR=0.87,CI=0.74-1.03,P>0.05)。
    结论:与外科口罩相比,使用N95呼吸器的医护人员的病毒感染发作较少。与本调查中包括的其他病毒相比,N95呼吸器在降低SARS-CoV1和2病毒在医院环境中病毒感染的风险方面最有效。方法学质量,偏见的风险,少量的原始研究表明有必要进行进一步的研究,尤其是在一线医疗服务中。
    OBJECTIVE: To examine the results, level of evidence, and methodologic quality of original studies regarding surgical mask effectiveness in minimizing viral respiratory illness transmission, and, in particular, the performance of the N95 respirator versus surgical mask.
    METHODS: Meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with use of PubMed, MEDLINE, and the Cochrane Library databases.
    RESULTS: Eight studies (9164 participants) were included after screening 153 articles. Analyses showed statistically significant differences between N95 respirator versus surgical mask use to prevent influenza-like-illness (risk ratio [RR] = 0.81, 95% confidence interval [CI] = 0.68-0.94, P < 0.05), non-influenza respiratory viral infection (RR = 0.62, 95% CI = 0.52-0.74, P < 0.05), respiratory viral infection (RR = 0.73, 95% CI = 0.65-0.82, P < 0.05), severe acute respiratory syndrome coronavirus (SARS-CoV) 1 and 2 virus infection (RR = 0.17, 95% CI = 0.06-0.49, P < 0.05), and laboratory-confirmed respiratory viral infection (RR = 0.75, 95% CI = 0.66-0.84, P < 0.05). Analyses did not indicate statistically significant results against laboratory-confirmed influenza (RR = 0.87, CI = 0.74-1.03, P > 0.05).
    CONCLUSIONS: N95 respirator use was associated with fewer viral infectious episodes for healthcare workers compared with surgical masks. The N95 respirator was most effective in reducing the risk of a viral infection in the hospital setting from the SARS-CoV 1 and 2 viruses compared to the other viruses included in this investigation. Methodologic quality, risk of biases, and small number of original studies indicate the necessity for further research to be performed, especially in front-line healthcare delivery settings.
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