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防止医疗操作过程中气溶胶化传染性颗粒的传播:一种廉价塑料围封装置的实验室分析。

Preventing spread of aerosolized infectious particles during medical procedures: A lab-based analysis of an inexpensive plastic enclosure.

机构信息

Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America.

Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America.

出版信息

PLoS One. 2022 Sep 22;17(9):e0273194. doi: 10.1371/journal.pone.0273194. eCollection 2022.

Abstract

Severe viral respiratory diseases, such as SARS-CoV-2, are transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures including tracheal intubation, extubation, dental work, and any procedure involving close contact with a patient's airways can increase exposure to infectious aerosol particles. This presents a significant risk for viral exposure of nearby healthcare workers during and following patient care. Previous studies have examined the effectiveness of plastic enclosures for trapping aerosol particles and protecting health-care workers. However, many of these enclosures are expensive or are burdensome for healthcare workers to work with. In this study, a low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during medical procedures, while also alleviating issues found in the design and use of other medical enclosures to contain aerosols. This enclosure is fabricated from clear polycarbonate for maximum visibility. A large single-side cutout provides health care providers with ease of access to the patient with a separate cutout for equipment access. A survey of medical providers in a local hospital network demonstrated their approval of the enclosure's ease of use and design. The enclosure with appropriate plastic covers reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 8 cm away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15-20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied. This enclosure is an inexpensive, easily implemented additional layer of protection that can be used to help contain infectious or otherwise potentially hazardous aerosol particles while providing access into the enclosure.

摘要

严重的病毒性呼吸道疾病,如 SARS-CoV-2,通过咳嗽、说话和呼吸产生的气溶胶颗粒传播。包括气管插管、拔管、牙科手术以及任何涉及与患者气道密切接触的程序,都可能增加感染性气溶胶颗粒的暴露。这对患者护理期间和之后附近医护人员的病毒暴露构成了重大风险。以前的研究已经检查了塑料外壳在捕获气溶胶颗粒和保护医护人员方面的有效性。然而,许多这些外壳昂贵或对医护人员来说使用起来很麻烦。在这项研究中,设计了一种低成本的塑料外壳,以减少医疗程序期间气溶胶的传播和病毒传播,同时缓解其他用于包含气溶胶的医疗外壳的设计和使用中发现的问题。该外壳由透明聚碳酸酯制成,具有最大的可见度。一个大的单边切口为医护人员提供了方便,可轻松接触患者,并有一个单独的切口供设备进入。对当地医院网络中的医疗提供者进行的一项调查表明,他们对外壳易于使用和设计表示认可。带有适当塑料盖的外壳可将所有开口 8 厘米处的总逃逸颗粒数浓度(直径>0.01μm)降低 93%以上。浓度衰减实验表明,在气管操作后,没有主动抽吸的外壳应留在患者身上 15-20 分钟,以确保>90%的气溶胶颗粒在内表面上沉降足够的时间。当应用 30 LPM 抽吸时,这一时间减少到 5 分钟。该外壳是一种廉价、易于实施的额外保护层,可以用来帮助控制传染性或其他潜在危险的气溶胶颗粒,同时提供进入外壳的通道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba00/9499281/a69800e42a35/pone.0273194.g001.jpg

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