Infection Prevention and Control

PERSONAL PROTECTIVE EQUIPMENT AND ITS RATIONAL USE COVID-19 Context (SARS-CoV-2)

 Personal Protective Equipment: COVID- 19 Pandemic (SARS-CoV-2)

 It is well known and publicly known that we are facing a pandemic caused by SARS-CoV-2 (COVID-19), with impacts that may never have been imagined, and that affects all world economies at the same time, and go beyond the field of public health.

The ideal way to prevent the transmission of microorganisms in a health organization, is to use a combination of interventions not only aimed at the use of personal protective equipment (PPE). Intervention actions must also combine isolation, visitation restrictions, correct hand washing, among other measures.

Hand hygiene practice is essential to prevent and control the spread of microorganisms. Health professionals, patients and visitors must be properly educated about the importance of their practice and monitored for its implementation. Routine hand washing before and after using PPE is a fundamental practice to maintain safety.

Attention:

 

All professionals should be instructed on how to put on, use and remove all recommended PPE.

One should not circulate through the health service using PPE. These must be removed immediately after leaving the room, ward or isolation area.

Wearing masks when not indicated can generate unnecessary costs and create a false sense of security, which can lead to neglect of other safety measures, such as hand hygiene.

Recommendations for personal protective equipment, according to the type of environment, target person and type of activity:

COVID-19 Context (SARS-CoV-2)

Table 1 presents the PPE recommendations to be used for the prevention and control of the spread of SARS-CoV-2 (COVID-19) according to a publication by the Ministry of Health.



* In addition to the appropriate use of PPE, frequent hand and respiratory hygiene should always be performed. PPE must be disposed of in an appropriate container after each use and hand hygiene must be carried out before and after using each PPE.
 
** Visitors must be restricted. If entry into the patient’s room with COVID-19 is extremely necessary, the procedures for placing and removing PPE and hand hygiene performed by the untrained visitor should be supervised by a health professional.
 
*** Includes non-touch thermometers, thermal imaging cameras, and questions / observations with a spatial distance of at least 1 meter.
 
**** All members of the Rapid Response Team must be trained in how to perform hand hygiene and how to put and remove PPE without being contaminated.

RATIONAL USE OF PPE – COVID-19 Context (SARS-CoV-2)

The health services that act in the direct confrontation of the pandemic by SARS-CoV-2 (COVID-19) have faced difficulties in the purchase and availability of equipment intended for the individual protection of their teams. The guidelines provided here do not represent an innovation or a contradiction to the “Technical Bulletins” or “Good Practices” for the use of personal protective equipment (PPE), they only act as a recommendation so that the unnecessary use of this equipment is reduced and contingency is established in the in case of shortage of any of the recommended PPE, at this moment of serious threat to public health.

Table 2 shows some contingency measures that can be taken during the crisis caused by SARS-CoV-2 (COVID-19) in case of shortage of PPE. To define the moment when contingency measures are used, in this table the terms Normal Capacity (PPE stocks within the expected range, the measures consist of providing assistance to the patient without any change in daily practices) and the COVID-19 Crisis (stock of PPE below expectations, the measures used are not always in accordance with the recommended good practices, but need to be performed due to the scarcity of resources and the system’s inability to limit the user’s access to the health service).

 

References

 

  1. Coronavirus Disease 2019 (COVID-19)
Strategies for Optimizing the Supply – COVID-19 – CDC.

 

  1. Coronavírus Informações seguras, baseadas em evidências – Equipamentos de Proteção Individual (EPI) – Conselho Federal de Farmácia – 2020.

 

  1. Orientações para serviços de saúde: Medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-CoV-2). ANVISA

 

  1. https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/category / higienizacao-das-maos. ANVISA

 

  1. Protocolo de Manejo Clínico para o Novo Coronavírus, Brasil – Ministério da Saúde.

 

  1. https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/05/Protocolo-de-manejo-clinico-para-o-novo-coronavirus-2019-ncov.pdf – Ministério da Saúde. Acesso em 25, março de 2020.

 

  1. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) – CDC. Acesso em 26, março de 2020.

 

  1. https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf – CDC. Acesso em 26, março de 2020.

 

  1. Nota técnica GVIMS/GGTES/ANVISA No 05/2020 – Orientações para a prevenção e o controle de infecções pelo novo coronavírus (SARS-Cov-2) em instituições de longa permanência para idosos (ILPI) – Gerência De Vigilância E Monitoramento Em Serviços de Saúde GVIMS Gerência geral de tecnologia em Serviços de Saúde – GGTES – Agência Nacional de Vigilância Sanitária – Anvisa
  2. Ueda M, Martins R, Hendrie PC, et al. Managing cancer care during the COVID-19 pandemic: Agility and collaboration toward a common goal [published online March 17, 2020]. J Natl Compr Canc Netw. doi: 10.6004/jnccn.2020.7560
  3. World Health Organization. WHO. Novel Coronavirus (2019-nCoV) technical guidance, 2020. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
  4. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting, 2020. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html
  5. Orientações Para A Prevenção E O Controle De Infecções Pelo Novo Coronavírus (SARS-CoV-2) em instituições de longa permanência para idosos (ILPI) – ANVISA 2020
  6. Centers for Disease Control and Prevention – CDC. Strategies for Optimizing the Supply of N95 Respirators: Crisis/Alternate Strategies. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternatestrategies.html Centers for Disease Control and Prevention – CDC. Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response, February 28, 2020, disponível em: https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html
  7. Nota técnica gvims/ggtes/anvisa nº 04/2020 orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-CoV-2). (atualizada em 21/03/2020)http://portal.anvisa.gov.br/documents/33852/271858/Nota+T%C3%A9cnica+n+04-2020+GVIMS-GGTES-ANVISA-ATUALIZADA/ab598660-3de4-4f14-8e6f-b9341c196b28
  8. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prepexternal icon. 2009;3(2 Suppl): S59-67.
  9. OSHA 2019 Novel Coronavirus websiteexternal ico
  10. http://portal.anvisa.gov.br/noticias?p_p_id=101_INSTANCE_FXrpx9qY7FbU&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&p_p_col_id=column&p_p_col_count=1&p_r_p_564233524_tag=covid-19

 

 

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