{"id":739,"date":"2020-03-23T17:20:37","date_gmt":"2020-03-23T14:20:37","guid":{"rendered":"https:\/\/genclikkomiteleri.org\/?p=739"},"modified":"2022-09-06T05:36:03","modified_gmt":"2022-09-06T02:36:03","slug":"saglik-emekcileri-icin-covid-19-kisisel-koruyucu-donanimi-ceviri-vjem","status":"publish","type":"post","link":"https:\/\/genclikkomiteleri.org\/2020\/03\/saglik-emekcileri-icin-covid-19-kisisel-koruyucu-donanimi-ceviri-vjem\/","title":{"rendered":"Sa\u011fl\u0131k emek\u00e7ileri i\u00e7in COVID-19 ki\u015fisel koruyucu donan\u0131m\u0131"},"content":{"rendered":"\n

Acil hekimleri ba\u015fta olmak \u00fczere, Covid-19 \u015f\u00fcpheli hastas\u0131yla temasta bulunan t\u00fcm sa\u011fl\u0131k emek\u00e7ileri (doktor, hem\u015fire, hasta bak\u0131c\u0131, ambulans s\u00fcr\u00fcc\u00fcs\u00fc, sedye yard\u0131mc\u0131lar\u0131 dahil) i\u00e7in al\u0131nmas\u0131 gereken \u00f6nlemleri anlatan Visual Journal of Emergency Medicine (VJEM) Dergisi taraf\u0131ndan haz\u0131rlanan makaleyi T\u00fcrk\u00e7e’ye \u00e7evirdik.<\/p>\n\n\n\n

1. Giri\u015f<\/strong><\/p>\n\n\n\n

Aral\u0131k 2019’da, \u00c7in Wuhan\u2019daki Hubei \u015fehrinde yeni bir koronavir\u00fcs enfeksiyonu tespit edildi. \u0130lk vakalar\u0131n hepsinin b\u00fcy\u00fck deniz \u00fcr\u00fcn\u00fc pazarlar\u0131 ve canl\u0131 hayvan pazarlar\u0131yla ortak bir ba\u011flant\u0131s\u0131 vard\u0131. Koronavir\u00fcsler, \u00e7o\u011fu so\u011fuk alg\u0131nl\u0131\u011f\u0131 vakalar\u0131na ve hayvanlardan insanlara bula\u015fan bir tak\u0131m viral hastal\u0131klara sebep olan geni\u015f bir vir\u00fcs s\u0131n\u0131f\u0131d\u0131r. \u0130simlerini elektron mikroskobu alt\u0131ndaki g\u00f6r\u00fcn\u00fcmlerinin g\u00fcne\u015f tutulmas\u0131na benzer olmas\u0131ndan \u00f6t\u00fcr\u00fc al\u0131rlar. (Bak\u0131n\u0131z \u015fekil 1 ve 2)1,2<\/sup><\/strong> Ya\u015fanmakta olan salg\u0131na sebep olan vir\u00fcse asl\u0131nda \u2018yeni koronavir\u00fcs\u2019 ismi verilmi\u015fti. \u015eimdi ise 2002-2003 y\u0131llar\u0131nda \u00c7in\u2019de salg\u0131na neden olan SARS vir\u00fcs\u00fc ile ba\u011flant\u0131s\u0131n\u0131n tespit edilmesi \u00fczerine SARS-CoV-2 ad\u0131n\u0131 ald\u0131. (O d\u00f6nemler vir\u00fcs\u00fcn misk kedilerinden kaynakland\u0131\u011f\u0131, onlardan insanlara atlad\u0131\u011f\u0131 ve MERS koronavir\u00fcs\u00fcn\u00fcn de develerden ge\u00e7ti\u011fi varsay\u0131ld\u0131.) https:\/\/www.cdc.gov\/coronavirus\/2019-nCoV\/summary.html<\/a>.<\/p>\n\n\n\n

Enfeksiyon \u015fimdi COVID-19 olarak adland\u0131r\u0131l\u0131yor ve \u00c7in\u2019den katlanarak artan yeni vaka bildirimlerinin g\u00f6sterdi\u011fi \u00fczere, COVID-19 enfeksiyonunun ki\u015fiden ki\u015fiye kolayl\u0131kla yay\u0131ld\u0131\u011f\u0131 birka\u00e7 hafta i\u00e7inde a\u00e7\u0131k\u00e7a anla\u015f\u0131ld\u0131. \u00c7in’den gelen yolcular arac\u0131l\u0131\u011f\u0131yla COVID-19\u2019un di\u011fer \u00fclkelere yay\u0131lmas\u0131 sonucu, D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc 30 Ocak 2020’de salg\u0131n dolay\u0131s\u0131yla K\u00fcresel Sa\u011fl\u0131k Acil Durumu ilan etti.3<\/sup><\/strong> Solunumsal korunma ve eldiven kullan\u0131m\u0131 ile ilgili sa\u011fl\u0131k kurumlar\u0131n\u0131n erken a\u015famadaki resmi tavsiyeleri, haber kanallar\u0131nda g\u00f6sterilen Asya \u00fclkelerindeki kamu yetkililerinin ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, Ebola veya tehlikeli madde kazalar\u0131nda kullan\u0131lanlar\u0131 and\u0131ran kapsaml\u0131 korunma te\u00e7hizat\u0131 giydi\u011fi g\u00f6r\u00fcnt\u00fcler ile keskin bir \u00e7eli\u015fki i\u00e7indeydi. Ba\u015flang\u0131\u00e7ta vir\u00fcs\u00fcn damlac\u0131klarla yay\u0131lmakta oldu\u011fu en olas\u0131 ihtimal olarak d\u00fc\u015f\u00fcn\u00fcl\u00fcyordu. Sonralar\u0131 enfeksiyonun do\u011fal seyri hala tam olarak anla\u015f\u0131lamad\u0131\u011f\u0131ndan, vir\u00fcs\u00fcn havadan ve temas yoluyla da bula\u015fabilece\u011fi y\u00f6n\u00fcnde g\u00f6r\u00fc\u015fler a\u011f\u0131rl\u0131k kazand\u0131. Enfeksiyon riski ve yay\u0131l\u0131m\u0131n\u0131n SARS’tan daha y\u00fcksek oldu\u011fu g\u00f6zlemlenmektedir. \u00d6yle ki, insanlar hi\u00e7 semptomatik hale gelmeden ya da tamamen iyile\u015fmi\u015f g\u00f6r\u00fcn\u00fcyorken bile enfeksiyonu bula\u015ft\u0131rabilmektedir. (Bak\u0131n\u0131z \u015fekil 34<\/sup>, 45,6<\/sup> ve 57<\/sup>)
<\/strong>(https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/about\/transmission.html<\/a>) <\/p>\n\n\n\n

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\u015eekil 1 (Koronavir\u00fcs – CDC)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n
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\u015eekil2 – (NASA: G\u00fcne\u015f Tutulmas\u0131 S\u0131ras\u0131nda G\u00fcne\u015f’in Coronas\u0131 – A\u011fustos 21, 2017)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n
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\u015eekil 3 (CDC – Bir hap\u015f\u0131rma ile havada ta\u015f\u0131nan par\u00e7ac\u0131klar) <\/strong><\/figcaption><\/figure><\/div>\n\n\n\n
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\u015eekil 4 (NIOSH- Onayl\u0131 N95 maskesi)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n
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\u015eekil 5 (N95 maskesinin kalitatif \u00e7\u00f6zeltilerle (izoamil asetat, sakarin, vb.) uygunluk testi)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n

2. Yay\u0131l\u0131m t\u00fcrleri ve \u00f6nlemler 8,9<\/sup><\/strong><\/p>\n\n\n\n

COVID-19 enfeksiyonundan \u015f\u00fcphelenilen ki\u015filer i\u00e7in acil hizmet sa\u011flay\u0131c\u0131lar\u0131 ve bu t\u00fcr hastalar ile ayn\u0131 oda veya b\u00f6l\u00fcmde bulunacak ki\u015filer, g\u00f6z korumas\u0131 kullan\u0131m\u0131 da dahil olmak \u00fczere CDC ve WHO taraf\u0131ndan \u00f6nerilen standartlara; temas ve hava kaynakl\u0131 \u00f6nlemlere uymal\u0131d\u0131rlar. Tedaviler negatif bas\u0131n\u00e7l\u0131 tek ki\u015filik izolasyon odalar\u0131nda g\u00f6r\u00fclmelidir. A\u015fa\u011f\u0131daki b\u00f6l\u00fcmlerde bu \u00f6nlemler a\u00e7\u0131klanmaktad\u0131r.


3. Standart \u00d6nlemler 10<\/sup><\/strong><\/p>\n\n\n\n

Hastal\u0131k Kontrol ve Korunma Merkezi, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n enfeksiyon kapma riskinden korunmas\u0131 ve enfeksiyonun hastalar aras\u0131nda yay\u0131lmas\u0131n\u0131 engellemek i\u00e7in, duruma uygun korunma pratikleri ve ki\u015fisel koruyucu ekipman kullan\u0131m\u0131n\u0131 standart \u00f6nlemler olarak tan\u0131ml\u0131yor. Bunlar, solunum hijyenini, uygun \u00f6ks\u00fcrme kurallar\u0131n\u0131, uygun hasta yerle\u015fimi\/izolasyonunu, hasta bak\u0131m\u0131 te\u00e7hizat\u0131n\u0131, ekipmanlar\u0131n\u0131, \u00e7ama\u015f\u0131r\u0131n\u0131, giyimini ve \u00e7evrenin temizli\u011fi ile bak\u0131m\u0131n\u0131 i\u00e7ermektedir.<\/p>\n\n\n\n


4. Temas ile Bula\u015f 11<\/sup><\/strong>   <\/p>\n\n\n\n

Enfeksiyonun enfekte olmu\u015f bir ciltten ba\u015fka bir cilde temas\u0131 yoluyla bula\u015fmas\u0131 veya bir ki\u015finin odas\u0131ndaki kontamine e\u015fyalara dokunarak (bula\u015f\u0131 muhtemel e\u015fyalar&malzemeler: hasta bak\u0131m ekipmanlar\u0131, telefonlar, TV uzaktan kumandalar\u0131, tezgahlar, yan\u0131 s\u0131ra yatak vb.) bula\u015fmas\u0131d\u0131r. Yara drenaj\u0131 veya v\u00fccut s\u0131v\u0131lar\u0131 (kusma, ishal, vb.) temas ile bula\u015fma riskini artt\u0131rmaktad\u0131r. Temas yoluyla bula\u015fan baz\u0131 \u00f6nemli patojenler \u015funlard\u0131r: Norovir\u00fcs, MRSA, C. difficile, VRE (Vankomisine Diren\u00e7li Enterokok), CRE (Karbapenem Diren\u00e7li Enterokok), SARS ve MERS.<\/p>\n\n\n\n

5. Solunum yolu ile bula\u015fma

<\/strong>Hastal\u0131klar\u0131n solunum yolu ile bula\u015fmas\u0131, belirli enfeksiyonlar\u0131 olan insanlar konu\u015ftu\u011funda, g\u00fcld\u00fc\u011f\u00fcnde, \u00f6ks\u00fcrd\u00fcg\u00fcnde, hap\u015f\u0131rd\u0131\u011f\u0131nda veya \u015fark\u0131 s\u00f6yledi\u011finde ortaya \u00e7\u0131kabilir. \u0130ki tipi vard\u0131r: damlac\u0131k ve havada as\u0131l\u0131 partik\u00fcller.<\/p>\n\n\n\n

6. Damlac\u0131k 12<\/sup>

<\/strong>Damlac\u0131k temas\u0131, bir hasta \u00f6ks\u00fcrd\u00fc\u011f\u00fc, hap\u015f\u0131rd\u0131\u011f\u0131 veya konu\u015ftu\u011fu zaman ortaya \u00e7\u0131kan damlac\u0131klar ba\u015fka bir ki\u015finin g\u00f6zlerine, burnuna veya a\u011fz\u0131na temas edince, bula\u015fan ki\u015fide enfeksiyona neden olarak ortaya \u00e7\u0131kar. Bu damlac\u0131klar olduk\u00e7a b\u00fcy\u00fckt\u00fcr, uzun s\u00fcre havada as\u0131l\u0131 kalmazlar ve olduk\u00e7a h\u0131zl\u0131 bir \u015fekilde \u00e7\u00f6kelirler. Basit bir \u015fekilde, hastaya tek kullan\u0131ml\u0131k bir maske takt\u0131rmak sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na bula\u015fabilirli\u011fi azaltacakt\u0131r. Damlac\u0131klar yoluyla bula\u015fabilen hastal\u0131klar; Grip, Meningokok Hastal\u0131\u011f\u0131, Hemophilus Influenza Tip B (HIB), Mikoplazma, Bo\u011fmaca, K\u0131zam\u0131k\u00e7\u0131k ve Kabakulak\u2019t\u0131r. <\/p>\n\n\n\n

Damlac\u0131k par\u00e7ac\u0131klar\u0131 havadan bula\u015fma potansiyeli olan di\u011fer partik\u00fcllerden daha b\u00fcy\u00fckt\u00fcr. Bu nedenle hastadan en az 1.83 metre (6 feet) uzakl\u0131kta bir mesafeyi korumak bile tek ba\u015f\u0131na yeterli olabilir. Negatif bas\u0131n\u00e7 odalar\u0131 gerekli de\u011fildir, ancak hastalar genellikle tek bir hasta odas\u0131nda izole edilir. Tek kullan\u0131ml\u0131k cerrahi maskeler ve prosed\u00fcr maskeleri, damlac\u0131k yoluyla bula\u015f a\u00e7\u0131s\u0131ndan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 i\u00e7in koruyucudur, ancak bir\u00e7ok kurum dikkatli olma taraf\u0131nda kalarak yan\u0131l\u0131r ve herhangi bir solunum yolu iletiminin \u00f6nlenmesi i\u00e7in N95 maskeleri \u00f6nerir. Yak\u0131n tarihli bir \u00e7al\u0131\u015fma, poliklinik ortamlar\u0131nda basit t\u0131bbi prosed\u00fcr maskelerinin Influenza\u2019ya kar\u015f\u0131 korunmakta N95 solunum maskeleri kadar etkili oldu\u011funu g\u00f6stermi\u015ftir.13<\/sup><\/strong> Bask\u0131n d\u00fc\u015f\u00fcnce koronavir\u00fcslerin (grip gibi) damlac\u0131klar yoluyla bula\u015ft\u0131\u011f\u0131 iken, salg\u0131n\u0131n ve bula\u015f\u0131c\u0131l\u0131\u011f\u0131n h\u0131zla yay\u0131lmas\u0131 havada as\u0131l\u0131 kalabilen partik\u00fcller yoluyla bula\u015ft\u0131\u011f\u0131n\u0131n daha olas\u0131 olabilece\u011fini g\u00f6steriyor. (a\u015fa\u011f\u0131ya bak\u0131n\u0131z)<\/p>\n\n\n\n

7. Havadaki Partik\u00fcller Yoluyla Bula\u015f 1<\/sup><\/strong><\/p>\n\n\n\n

Havadan bula\u015fma, daha k\u00fc\u00e7\u00fck damlac\u0131k \u00e7ekirdeklerinin veya patojeni i\u00e7eren toz par\u00e7ac\u0131klar\u0131n\u0131n uzun s\u00fcre (2 saat veya daha fazla) havada as\u0131l\u0131 kalabildi\u011fi ve havada daha uzun s\u00fcre as\u0131l\u0131 kald\u0131klar\u0131ndan hastadan ayr\u0131ld\u0131ktan sonra \u00e7ok daha fazla mesafe kat edebildi\u011fi durumlar\u0131 ifade eder. COVID-19 ve di\u011fer hava yoluyla bula\u015fan hastal\u0131klar\u0131 olan hastalar\u0131n negatif bas\u0131n\u00e7 odalar\u0131na ihtiyac\u0131 vard\u0131r. Hava yoluyla bula\u015fan di\u011fer hastal\u0131klar aras\u0131nda t\u00fcberk\u00fcloz, su \u00e7i\u00e7e\u011fi ve k\u0131zam\u0131k bulunur. Bu hastal\u0131klar damlac\u0131ktan \u00e7ok daha bula\u015f\u0131c\u0131d\u0131r ve daha y\u00fcksek d\u00fczeyde solunum korumas\u0131 gereklidir. NIOSH (ABD Ulusal \u0130\u015f Sa\u011fl\u0131\u011f\u0131 ve G\u00fcvenli\u011fi Enstit\u00fcs\u00fc), COVID-19 hastalar\u0131na bakan t\u00fcm personel i\u00e7in uygun \u015fekilde test edilmi\u015f N95 solunum cihazlar\u0131n\u0131 \u00f6nerir (a\u015fa\u011f\u0131ya bak\u0131n\u0131z).<\/p>\n\n\n\n

8. Ki\u015fisel Koruyucu Donan\u0131m (KKD)

8.1. Solunum

<\/strong>COVID-19’dan havadaki partik\u00fcller yoluyla bula\u015ftan korunmak i\u00e7in N-95 solunum cihazlar\u0131 (\u015eekil 3, 4, 5 ve 615<\/sup>)<\/strong> gereklidir. OSHA (Occupational Safety and Health Administration – \u0130\u015f Sa\u011fl\u0131\u011f\u0131 ve G\u00fcvenli\u011fi \u0130daresi, ABD) y\u00f6netmeliklerine g\u00f6re, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, maskenin kullan\u0131c\u0131n\u0131n cildiyle uygun bir s\u0131zd\u0131rmazl\u0131k sa\u011flad\u0131\u011f\u0131ndan ve yeterli koruma sundu\u011fundan emin olmak i\u00e7in kalitatif veya kantitatif bir cihazla uygun \u015fekilde test edilmek zorundad\u0131r. Kullan\u0131c\u0131lar, maske kullan\u0131m\u0131 ve uyum testi i\u00e7in temiz tra\u015fl\u0131 olmal\u0131d\u0131r. Birden fazla \u00fcreticiden \u00e7ok say\u0131da marka mevcuttur. (a\u015fa\u011f\u0131daki NIOSH web sitesinden foto\u011fraflar\u0131na bak\u0131n) Sakall\u0131 kullan\u0131c\u0131lar N95 ile test edilemez, \u00e7\u00fcnk\u00fc yeterli bir s\u0131zd\u0131rmazl\u0131k m\u00fcmk\u00fcn de\u011fildir.17<\/sup><\/strong> Sakall\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131, ba\u015fl\u0131kl\u0131 bir hava temizleyici solunum cihaz\u0131 (PAPR) kullanabilir, \u00e7\u00fcnk\u00fc bunlar s\u0131k\u0131 bir cilt konta\u011f\u0131na ihtiya\u00e7 duymadan \u00e7al\u0131\u015f\u0131r ve bu nedenle de uygunluk testi gerektirmez (foto\u011fraflara bak\u0131n).<\/p>\n\n\n\n

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\u015eekil 6 (Hava yoluyla bula\u015fmaya kar\u015f\u0131 korunma i\u00e7in y\u00fcz siperi ve N95 maskesi)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n

\u2018N95\u2019 adland\u0131r\u0131m\u0131 NIOSH’dan geliyor, yani asl\u0131nda k\u00fc\u00e7\u00fck par\u00e7ac\u0131klar\u0131n % 95’ini filtreleyen, ancak ya\u011fa diren\u00e7li olmayan bir toz buhar\u0131 solunum cihaz\u0131d\u0131r (N = Not(Yok) ; 95 = % 95 filtrasyon verimlili\u011fi). Bir R95 ayn\u0131 filtreleme kapasitesine sahiptir, ancak ya\u011fl\u0131 \u00e7\u00f6z\u00fcc\u00fcler i\u00e7in \u00f6nerilir (R = Recommended (\u00d6nerilir) ). P100 gibi daha y\u00fcksek adland\u0131rmalar, par\u00e7ac\u0131klar\u0131n % 99.99’unu filtreledi\u011fi anlam\u0131na gelir (P = Particles (Par\u00e7ac\u0131klar); 100 = esasen % 100 verimlilik). Bir durum N95 gerektiriyorsa ve bir N95 mevcut de\u011filse, daha y\u00fcksek koruma seviyeleri (yani, R95, P100) kabul edilebilir, fakat daha d\u00fc\u015f\u00fck koruma seviyeleri (yani basit prosed\u00fcr veya cerrahi maske) de\u011fil, korumaz. (\u015eekil 12)<\/strong><\/p>\n\n\n\n

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\u015eekil 7 (Foto\u011fraflar 3M, Kimberly-Clark ve Moldex(^18)’in izniyle)<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n


<\/strong>N95 maskelerinin baz\u0131 stiller mevcuttur. (\u015eekil7) <\/strong>OSHA, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 i\u00e7in N95 maskelerini solunum koruma cihazlar\u0131 olarak ilan etti\u011finden beri, onlar\u0131n kullan\u0131m\u0131 OSHA Solunum Koruma Standard\u0131 \u20181910.13419<\/sup><\/strong>\u2019a tabiidir. \u0130\u015fverenler a\u015fa\u011f\u0131daki bile\u015fenlere sahip bir programa sahip olmak zorundad\u0131r:<\/p>\n\n\n\n