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Colegio de Medicina Interna de México.

2021, Número 6

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Med Int Mex 2021; 37 (6)


Cubrebocas y respiradores. Alternativas para los trabajadores de la salud en la pandemia de COVID-19

Ramírez-Guerrero JA

Idioma: Español
Referencias bibliográficas: 55
Paginas: 1030-1044
Archivo PDF: 324.67 Kb.


RESUMEN

La pandemia de COVID-19 ha repercutido de manera importante entre los trabajadores de la salud, derivado, entre otros factores, de la carencia de equipo de protección personal adecuado, sobre todo de cubrebocas médicos y respiradores. En este trabajo se revisan la formas de transmisión, donde debe reconocerse que la principal vía de contagios es a través de aerosoles, micropartículas menores a 60-100 micras que se exhalan durante la realización de un procedimiento generador de aerosol y también con la tos, estornudos o el habla y que son capaces de permanecer flotando por tiempo prolongado en espacios cerrados. Mientras que los respiradores purificadores de aire N95 son los indicados para el cuidado de los pacientes con diagnóstico o sospecha de COVID-19 por ofrecer mayor protección contra los aerosoles, éstos no siempre están disponibles por su escasez debido a su elevado consumo en todo el mundo. En esta revisión se analizan la alternativas más adecuadas ante la crisis de desabasto tratando de dar prioridad a aquéllos hechos de materiales con alta eficacia filtrante y un sellado facial adecuado para evitar fugas. La aparición de nuevas variedades más contagiosas del virus SARS-CoV-2 debe obligar a todos los trabajaodres de la salud a usar en todo momento en el entorno hospitalario los respiradores o cubrebocas médicos con mayor eficacia y no solo durante la realización de un procedimiento generador de aerosol.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. https://www.who.int/es/news/item/27-04-2020-whotimeline--- covid-19.

  2. Chou R, Dana T, Buckley DI, Selph S, et al. Update Alert 5: Epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med 2020 Dec 1; 173 (11): W154-W55. doi: 10.7326/L20-1227.

  3. Chávez V. En México hay más muertos y contagios de personal médico que en Italia y EU. El Financiero, 1 de junio 2020.

  4. Forbes Staff. México, el país con más personal médico muerto por coronavirus. https://www.forbes.com.mx/ noticias-mexico-pais-con-mas-personal-medico-muertopor- coronavirus/

  5. Chou R, Dana T, Buckley DI, Selph S, et al. Epidemiology of and risk factors for coronavirus infection in health care workers. A Living Rapid Review. Ann Intern Med 2020 Jul 21; 173 (2): 120-136. doi: 10.7326/M20-1632.

  6. Davies N, Barnard R, Jarvis C, Kucharski A, et al. Estimated transmissibility and severity of novel SARS-CoV-2 Variant of Concern 202012/01 in England. CMMID Repository Status: Paper under peer review | First online: 23-12-2020 | Last update: 31-12-2020. https://doi.org/10.1101/2020 .12.24.20248822.

  7. McNeil Jr D. How much herd immunity is enough? The Ney York Times. Dec 24, 2020.

  8. National Academies of Sciences, Engineering and Medicine. 2020. Airborne Transmission of SARS-CoV-2: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/25958.

  9. Morawska L, Milton DK. It’s time to address airborne transmission of Coronavirus disease 2019 COVID-19. Clin Infect Dis 2020 Dec 3; 71 (9): 2311-2313. doi: 10.1093/ cid/ciaa939.

  10. How COVID-19 Spreads. https://www.cdc.gov/coronavirus/ 2019-ncov/prevent-getting-sick/how-covid-spreads.html.

  11. Jennison MW. Atomizing of mouth and nose secretions into the air as revealed by high-speed photography. Aerobiology. 17th ed. Washington: American Association for the Advancement of Science, 1942: pp 106-28.

  12. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA 2020; 323 (18): 1837-1838. doi: 10.1001/jama.2020.4756.

  13. Zuo Y, Uspal W, Wei T. Airborne Transmission of COVID-19: Aerosol dispersion, lung deposition, and virus-receptor interactions. ACS Nano 2020; 14: 16502-16524. doi: 10.1021/ acsnano.0c08484.

  14. Yu ITS, Li Y, Wong TW, Tam W, et al. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 2004; 350: 1731-1739. doi: 10.1056/ NEJMoa032867.

  15. Kim SH, Chang SY, Sung M, Park J, et al. Extensive viable Middle East Respiratory Syndrome (MERS) coronavirus contamination in air and surrounding environment in MERS isolation wards. Clin Infect Dis 2016; 63: 363-369. doi: 10.1093/cid/ciw239.

  16. Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis 2006; 12: 1657-1662. doi: 10.3201/ eid1211.060426.

  17. Ong SWT, Tan YK, Chia PY, Lee TH, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA 2020; 323: 1610-2. doi: 10.1001/jama.2020.3227.

  18. Lednicky JA, Lauzardo M, Fan ZH, Jutla AS, Tilly TB, Gangwar M, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis 2020; 100:476-82. doi: 10.1016/j.ijid.2020.09.025.

  19. van Doremalen N, Bushmaker T, Morris DH, Holbrook M, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020; 382:1564-1567. doi: 10.1056/NEJMc2004973.

  20. Shen Y, Li C, Dong H, Wang Z, Martinez L, Sun Z, et al. Community outbreak investigation of SARS-CoV-2 transmission among bus riders in Eastern China. JAMA Intern Med 2020; 180: 1665-71. doi: 10.1001/jamainternmed.2020.5225.

  21. Li Y, Qian H, Hang J, Chen X, et al. Aerosol transmission of SARS-CoV-2. Evidence for probable aerosol transmission of SARS-CoV-2 in a poorly ventilated restaurant. medRxiv 2020.04.16.20067728. doi: https://doi.org/10.1101/202 0.04.16.20067728.

  22. Hamner L, Dubbel P, Capron I, Ross A, et al. High SARSCoV- 2 attack rate following exposure at a choir practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69. http://dx.doi.org/10.15585/ mmwr.mm6919e.

  23. Kang M, Wei J, Yuan J, Guo J, Zhang Y, Hang J, et al. Probable evidence of fecal aerosol transmission of SARS-CoV-2 in a high-rise building. Ann Intern Med 2020; Sep 1:M20-0928. doi: 10.7326/M20-0928.

  24. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ infection-control-recommendations.html.

  25. World Health Organization. Advice on the use of masks in the context of COVID-19. Interim guidance. 5 June 2020.

  26. World Health Organization. Mask use in the context of COVID-19. Interim guidance. 1 december 2020.

  27. ¿Por qué Alemania pide a ciudadanos usar solo mascarillas quirúrgicas? Milenio, 22 enero 2021.

  28. https://www.primed.ca/resources/astm-mask-protectionstandards/.

  29. Brosseau L., Berry R. N95 respirators and surgical masks. Center for disease control and prevention. Posted on October 14, 2009. https://blogs.cdc.gov/niosh-scienceblog/ 2009/10/14/n95/.

  30. Diario Oficial de la Federación. http://dof.gob.mx/nota_detalle_ popup.php?codigo=5227732.

  31. Hospital Respiratory Protection Program Toolkit Resources for Respirator Program Administrators. May 15, 2015. National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory (NIOSH-NPPTL). https://www.osha.gov/sites/default/files/ publications/OSHA3767.pdf.

  32. https://multimedia.3m.com/mws/media/1793275O/3ma nz-2020-comparison-of-ffp2-kn95-and-n95-and-other-filtering-facepiece-respirator-classes.pdf.

  33. Implementing Filtering Facepiece Respirator (FFR) reuse, including reuse after decontamination, when there are known shortages of N95 Respirators. Updated. Oct.19, 2020. Disponible en: https://www.cdc.gov/ coronavirus/2019-ncov/hcp/ppe-strategy/decontamination- reuse-respirators.html.

  34. Clark DB. Inside the chaotic, cutthroat gray market for N95 masks. The New York Times Magazine. Published Nov 17, 2020.

  35. He X, Vo E, Horvatan M, Liu Y, et al. Comparison of simulated workplace protection factors offered by N95 and P100 filtering facepiece and elastomeric half-mask respirators against particles of 10 to 400 nm. J Nanotechnol Mater Sci 2015; 2: 1-6. doi: 10.15436/2377-1372.15.015.

  36. National Academies of Sciences, Engineering, and Medicine 2019. Reusable elastomeric respirators in Health care: considerations for routine and surge use. Washington, DC: The National Academies Press. http://doi.org/10.17226/25275.

  37. NIOSH-Approved N95 particulate filtering facepiece respirators. Updated December 30, 2020. https://www.cdc.gov/ niosh/npptl/topics/respirators/disp_part/N95list1-b.html.

  38. Sickbert-Bennett E, Samet JM, Clapp PW, Chen H, et al. Filtration efficiency of hospital face mask alternatives available for use during the COVID-19 Pandemic. JAMA Intern Med 2020 Aug 11; e204221. doi: 10.1001/jamainternmed. 2020.4221.

  39. US Food & Drug Administration. N95 Respirators, Surgical Masks, and Face Masks. June 7, 2020. Available at https:// www.fda.gov/medical-devices/personal-protectiveequipment- infection-control/n95-respirators-surgicalmasksand- face-masks#decontaminating. Accessed July 1,2020.

  40. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). https://www.cdc.gov/infectioncontrol/ guidelines/disinfection/tables/figure1.html.

  41. Chin AWH, Chu JTS, Perera MRA, Hui KPY, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe, 2020; 1: e10. doi: 10.1016/S2666- 5247(20)30003-3.

  42. van Doremalen N, Bushmaker T, Morris DH, Holbrook M, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Eng J Med 2020; 382: 1564-1567. doi: 10.1056/NEJMc2004973.

  43. Chan KH, Sridhar S, Zhang RR, Shu H, et al. Factors affecting stability and infectivity of SARS-CoV-2. J Hosp Infect 2020; 106: 226-231. doi: 10.1016/j.jhin.2020.07.009.

  44. Ratnesar-Shumate S, Williams G, Green B, Krause M, et al. Simulated sunlight rapidly SARS-CoV-2 on surfaces. J Infect Dis 2020 Jun 29; 222 (2): 214-222. doi: 10.1093/ infdis/jiaa274.

  45. N95 Decontamination & Reuse Method Decision Matrix. https://www.n95decon.org/publications#n95-respiratorfacts.

  46. Degesys NF, Wang RC, Kwan E, Noble J, Fahimi J, Raven M. Correlation between N95 extended use and reuse and fit failure in an emergency department. JAMA 2020 Jul 7; 324 (1): 94-96. doi: 10.1001/jama.2020.9843.

  47. Maranhao B, Scott AW, Scott AR, Maeng J, et al. Probability of fit failure with reuse of N95 mask respirators. Br J Anaesth 2020 Sep; 125 (3): e322-e324. doi: 10.1016/j.bja.2020.06.023.

  48. https://www.astm.org/READINGLIBRARY/VIEW/F2100. html.

  49. Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control 2008 May; 36 (4): 276-82. doi: 10.1016/j.ajic.2007.07.008.

  50. Runde DP, Harland KK, Van Heukelom P, Faine B, O’Shaughnessy P, Mohr NM. The “double eights mask brace” improves the fit and protection of a basic surgical mask amidst COVID-19 pandemic. JACEP Open 2021; 2: e12335. doi: 10.1002/emp2.12335.

  51. Drewnick F, Pikmann J, Fachinger F, Moormann L, Sprang F, Borrmann S, et al. Aerosol filtration efficiency of household materials for homemade face masks: Influence of material properties, particle size, particle electrical charge, face velocity, and leaks. Aerosol Science and Technology 2021, 55: 63-79. https://doi.org/10.1080/02786826.2020.1817846.

  52. Pan J, Harb C, Leng W, Marr LC. Inward and outward effectiveness of cloth masks, a surgical mask, and a face shield. Posted November 20, 2020. doi: https://doi. org/10.1101/2020.11.18.20233353 medRxiv preprint.

  53. Mueller AV, Eden MJ, Oakes JM, Bellini C, Fernandez L. Quantitative method for comparative assessment of particle removal efficiency of fabric masks as alternatives to standard surgical masks for PPE. Matter 2020; 3: 950-962. doi: 10.1016/j.matt.2020.07.006.

  54. https://www.fixthemask.com.

  55. Clapp P, Sickbert-Bennett EE, Samet JM, Berntsen J, et al. Evaluation of cloth masks and modified procedure masks as personal protective equipment for the public during the COVID-19 pandemic. JAMA Intern Med 2021; 181 (4): 463-469. doi:10.1001/jamainternmed.2020.8168.




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