A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2.
A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2.
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DOI：
10.7196/ajtccm.2021.v27i4.173
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发表时间：
2021
影响因子：
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通讯作者：
Churchyard GJ
中科院分区：
文献类型：
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作者：
Dheda K;Charalambous S;Karat AS;von Delft A;Lalloo UG;van Zyl Smit R;Perumal R;Allwood BW;Esmail A;Wong ML;Duse AG;Richards G;Feldman C;Mer M;Nyamande K;Lalla U;Koegelenberg CFN;Venter F;Dawood H;Adams S;Ntusi NAB;van der Westhuizen HM;Moosa MS;Martinson NA;Moultrie H;Nel J;Hausler H;Preiser W;Lasersohn L;Zar HJ;Churchyard GJ
严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) 主要通过 <10 µm 颗粒的气溶胶传播，这些颗粒在吸入前可保持悬浮数小时。由于颗粒过滤面罩呼吸器（“呼吸器”；例如 N95 口罩）比外科口罩更能有效抵御生物气溶胶，因此许多国际组织现在建议卫生工作者 (HW) 在护理可能患有 COVID-19 的个人时佩戴呼吸器。然而，在南非 (SA)，仍然建议对疑似或确诊的 COVID-19 患者进行日常护理时使用外科口罩，并为所谓的气溶胶产生程序保留呼吸器。相比之下，南非指南确实建议对可能患有或确诊患有结核病 (TB) 的个人进行常规护理时使用呼吸器，结核病也通过气溶胶传播。在南澳的卫生机构中，如果不进行检查和调查，区分结核病和 COVID-19 是一项挑战，这两者都可能使医护人员接触潜在的感染者。基于症状的分类在定义风险方面的效用有限。事实上，很大比例的 COVID-19 和/或肺结核患者可能没有症状和/或检测呈阴性。因此，在许多普通临床区域（例如等候区），未确诊的呼吸道疾病的患病率可能很高。此外，一部分卫生工作者艾滋病毒呈阳性，罹患重症 COVID-19 和死亡的风险增加。 感染预防和控制 (IPC) 的持续改进需要重组系统，以优先考虑硬件和患者的安全。虽然这需要时间，但在做出此类更改之前让硬件暴露是不可接受的。我们建议南澳卫生系统采用“零伤害”目标，旨在消除呼吸道病原体向每个医疗机构中所有人的传播。 因此，我们建议： 所有工作人员（临床和非临床）在涉及与以下人员在室内空间接触或共享空气的活动期间使用呼吸器： (i) 尚未经过临床评估； (ii) 被认为或已知患有结核病和/或 COVID-19 或其他潜在有害的呼吸道感染；使用符合国家和国际制造标准的呼吸器；至少通过定性适合性测试对所有呼吸器进行评估；根据国际 IPC 建议，使用呼吸器作为“一揽子护理”的一部分。我们认识到这将具有挑战性，尤其是由于全球和国家个人防护装备（PPE）的短缺。南澳有关呼吸防护设备的国家政策为制造和质量控制提供了强有力的框架，并得到了当地制造商和贸易、工业和竞争部的支持。呼吸器制造商应探索改进措施，以提高舒适度并减少沟通障碍。迫切需要进行结构性变革，以提高卫生设施的安全性：围绕潜在系统变革的持续倡导和研究仍然至关重要。
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators (‘respirators’; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of ‘zero harm’, aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections; the use of respirators that meet national and international manufacturing standards; evaluation of all respirators, at the least, by qualitative fit testing; and the use of respirators as part of a ‘package of care’ in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential.