Differences in national COVID-19 guidelines have caused confusion for medical professionals

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Differences in national and international guidelines for respiratory protection have created confusion among healthcare professionals, according to a new study presented at this year’s European Conference on Clinical Microbiology and Infectious Diseases (ECCMID), held online this year. I am.

Differences in guidelines for the use of surgical masks and respiratory organs in different countries and organizations in fast-moving situations such as pandemics can lead to confusion and anxiety. Healthcare professional, And lack of confidence in the device’s ability to prevent SARS-CoV-2 infection.

Dr. Gabriel Burgand and his colleagues at Imperial College London, London, UK, January 1-December 31, 2020, published guidelines for infection prevention and control published by major organizations and agencies in the United Kingdom, France, Germany and the United States. Was analyzed. And I investigated their potential reasons.

It also included guidelines from two international organizations, the World Health Organization (WHO) and the European Center for Disease Prevention and Control (ECDC). A monthly check on the official website collected 114 different guidelines, 59 of which were targeted for hospital respiratory protection and were included in the analysis.

The team then extracted the following data for each of the 59 guidelines:Organization name
Publication date; Recommended type of respiratory protection. Indications for use; List of Aerosol Generation Procedures (AGP).

Two types of respiratory protection were recommended: surgical face mask (SM) and respiratory (N95 / 99, FFP2 / 3). The indications for the use of surgical face masks have been divided into three categories.

  • Please contact only with suspicious or confirmed cases.
  • Targeted continuous use (SM worn by all healthcare professionals throughout the shift in the clinical field, including areas with patients other than COVID-19).
  • Universal face masking (SM worn by all medical professionals when entering the hospital).

The three indications for using a respirator are:

  • Contact with suspicious or confirmed cases.
  • Intended for continuous use in high-risk areas.
  • Only during AGP.

The first guidelines in all four countries recommend that medical professionals in direct contact with suspected or confirmed cases of COVID-19 use the respiratory tract. (See poster graphic-see link below).

In early February 2020, ECDC and WHO emphasized that the main mode of infection is by droplets and that the risk of aerial transmission is largely present during AGP.

On February 10, the ECDC confirmed that SM could be worn when caring for COVID-19 patients when the respiratory system was unavailable. However, AGP requires you to wear a respirator. The Centers for Disease Control and Prevention (CDC) repeated this guidance in the United States a month later. However, Germany continued to recommend the use of the respiratory tract in treating all suspected and confirmed cases of the virus.

In late February, WHO first recommended wearing SM when caring for all patients with suspected or confirmed cases of the virus, limiting respiratory use to AGP. France soon followed this strategy.

This meant that the four countries had different strategies for respiratory use. Germany used them in all COVID-19 and suspect cases, while France used them only in AGP. The United States has taken a flexible approach of using a surgical mask when the respiratory system is unavailable, and the United Kingdom is unit-based using the respiratory system in high-risk units such as intensive care units for COVID-19 patients. Adopted the strategy of.

Germany was the first country to introduce universal face masking on March 22, followed by the United States on April 13 and France on May 6. The UK waited until August 20 to introduce the measure. The authors state that the SM deficiency and the uncertainty surrounding the asymptomatic infection of COVID-19 may explain some of the delays in following the German example.

The definitions of what constitutes an AGP have changed over time by country, organization, and time. A total of 13 different guidelines defined the AGP and provided a list of 3 to 14 steps. Intubation / extubation and bronchoscopy were the most frequently mentioned. The authors state that further research is needed to clearly define both what constitutes an AGP and the level of risk of individual procedures.

They conclude that lack of equipment and lack of scientific knowledge about viruses may have contributed to the variation in guidelines.

Dr. Burgund adds: “The discrepancy in respiratory protection guidelines between neighboring countries has caused confusion about optimal measures. In such situations, strong cooperation between national and international organizations is important.”

Surgical face masks provide protection against aerosols, but face shields do not.

Courtesy of the European Society of Clinical Microbiology and Infectious Diseases

Quote: Due to differences in national COVID-19 guidelines, medical professionals (June 24, 2021) from to 2021 Obtained on June 24, 2014.

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Differences in national COVID-19 guidelines have caused confusion for medical professionals

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