Source avec lien : Occupational and Environmental Medicine, (Prépublication), 26 janvier 2021. 10.1136/oemed-2020-107058
Cette étude synthétise les données concernant la gamme de respirateurs filtrants adaptés aux soins des patients afin de guider la sélection et l’utilisation des différents types de respirateurs. L’étude a abouti à quatre conclusions principales. Premièrement, les normes internationales sont largement comparables d’une juridiction à l’autre. Deuxièmement, l’utilisation efficace et sûre des respirateurs dépend d’un ajustement approprié et de tests d’ajustement. Troisièmement, tous les types d’appareils de protection respiratoire entraînent pour l’utilisateur une gêne et des interférences avec la communication qui peuvent limiter leur utilisation sûre sur de longues périodes ; il existe peu de preuves de l’impact d’un port prolongé. Enfin, certaines activités cliniques, en particulier les compressions thoraciques, réduisent les performances des respirateurs à masque filtrant.
Objectives To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. Design Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. Data sources Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. Study selection Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. Results We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. Conclusion A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.