From the NIHR Global Health Research Group on Neurotrauma (D.P.G., A.K., P.J.H., A.M.R.), University of Cambridge; Division of Neurosurgery (D.P.G., A.K., P.J.H.), Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Clinical Research Center (A.G.), Fundación Valle del Lili, Cali; Neuroscience Institute (A.M.R.), INUB-MEDITECH Research Group, El Bosque University, Bogotá; and Neurological Surgery Service (A.M.R.), Vallesalud Clinic, Cali, Colombia.
J Trauma Acute Care Surg. 2021 Apr 1;90(4):e72-e80. doi: 10.1097/TA.0000000000003073.
Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients.
We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).
Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.
The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations.
Review, level II.
中低收入国家的医疗保健机构资源不足，无法遵守当前的 COVID-19 预防建议。 外科急诊创伤护理措施的建议需要充分利用现有证据，并适应特定环境。 为了为未来的建议提供信息，我们旨在总结不同个人防护设备 (PPE) 对护理创伤手术患者的卫生保健人员感染 COVID-19 的风险的影响。
我们使用 COVID-19 生活综述证据平台进行了伞式审查，该平台定期在 MEDLINE、Embase、Cochrane 对照试验中心注册和 30 多个其他来源中进行自动搜索。 纳入了评估 PPE 疗效的实验和观察性研究的系统评价。 还考虑了来自其他医疗保健环境的间接证据。 使用 AMSTAR II 工具（评估系统评价方法学质量，安大略省渥太华，加拿大）评估偏倚风险，并使用推荐评估、制定和评估方法（在国际前瞻性系统评价注册处注册，CRD42020198267）报告证据确定性的分级。
符合选择标准的 18 项研究被纳入。 与不戴口罩相比，使用 N95 呼吸器和手术口罩可显著降低 COVID-19 的风险。 在中高风险环境中，与手术口罩相比，N95 呼吸器可进一步降低 COVID-19 感染的风险。 在这种情况下，眼部保护也可降低感染的风险。 使用紫外线杀菌照射、蒸气过氧化氢或干热对口罩和呼吸器进行消毒是有效的，并且不会影响 PPE 的性能或贴合度。
与不戴口罩相比，PPE 的使用可大大降低医护人员感染 COVID-19 的风险。 N95 及同等呼吸器比手术口罩提供更好的保护。 去污和再利用似乎可以克服 PPE 短缺问题，并增强有限资源的分配。 这些效果适用于急诊创伤护理，并应告知未来的建议。
综述，二级。
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