{"id":3223,"date":"2021-02-11T16:42:55","date_gmt":"2021-02-11T16:42:55","guid":{"rendered":"https:\/\/infection.crto.on.ca\/aerosol-generating-respiratory-procedures\/"},"modified":"2023-05-15T14:19:06","modified_gmt":"2023-05-15T14:19:06","slug":"aerosol-generating-respiratory-procedures","status":"publish","type":"page","link":"https:\/\/infection.crto.on.ca\/fr\/aerosol-generating-respiratory-procedures\/","title":{"rendered":"Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols"},"content":{"rendered":"

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Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols<\/strong><\/h1>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1″ _builder_version=\u00a0\u00bb4.16″ custom_padding=\u00a0\u00bb0px||0px|\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row use_custom_gutter=\u00a0\u00bbon\u00a0\u00bb gutter_width=\u00a0\u00bb1″ module_class=\u00a0\u00bb et_pb_row_fullwidth\u00a0\u00bb _builder_version=\u00a0\u00bb4.16″ width=\u00a0\u00bb100%\u00a0\u00bb width_tablet=\u00a0\u00bb100%\u00a0\u00bb width_phone=\u00a0\u00bb\u00a0\u00bb width_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb max_width_tablet=\u00a0\u00bb100%\u00a0\u00bb max_width_phone=\u00a0\u00bb\u00a0\u00bb max_width_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb custom_padding=\u00a0\u00bb0px||0px|\u00a0\u00bb border_color_all=\u00a0\u00bbrgba(0,0,0,0)\u00a0\u00bb make_fullwidth=\u00a0\u00bbon\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.16″ custom_padding=\u00a0\u00bb|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb custom_padding__hover=\u00a0\u00bb|||\u00a0\u00bb][et_pb_divider color=\u00a0\u00bb#81AC50″ divider_weight=\u00a0\u00bb3px\u00a0\u00bb disabled_on=\u00a0\u00bboff|off|off\u00a0\u00bb _builder_version=\u00a0\u00bb4.16″ height=\u00a0\u00bb0px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1″ _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_image=\u00a0\u00bbhttps:\/\/infection.crto.on.ca\/wp-content\/uploads\/sites\/18\/2021\/02\/crto-patterngreen-tall.jpg\u00a0\u00bb background_position=\u00a0\u00bbbottom_left\u00a0\u00bb border_width_bottom=\u00a0\u00bb3px\u00a0\u00bb border_color_bottom=\u00a0\u00bb#81AC50″ global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.20.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n

Des pr\u00e9cautions doivent \u00eatre prises pour r\u00e9duire le niveau de production d\u2019a\u00e9rosols. L\u2019\u00e9valuation des risques doit \u00eatre effectu\u00e9e sur le lieu o\u00f9 sont prodigu\u00e9s les soins. Les pratiques de base sont suffisantes pour les proc\u00e9dures m\u00e9dicales g\u00e9n\u00e9ratrices d\u2019a\u00e9rosols effectu\u00e9es sur des patients ne pr\u00e9sentant aucun signe ou sympt\u00f4me de tuberculose suspect\u00e9e ou confirm\u00e9e, de syndrome respiratoire aigu s\u00e9v\u00e8re ou d\u2019infection respiratoire par un pathog\u00e8ne \u00e9mergent dont les caract\u00e9ristiques de transmission ne sont pas encore connues.<\/p>\n

Pour toute proc\u00e9dure pouvant g\u00e9n\u00e9rer des gouttelettes respiratoires (a\u00e9rosolisation), y compris les proc\u00e9dures \u00e9num\u00e9r\u00e9es \u00e0 la page suivante, sur des patients pr\u00e9sentant des signes et des sympt\u00f4mes de tuberculose (TB), de SRAS ou d\u2019infection respiratoire par un pathog\u00e8ne respiratoire \u00e9mergent, suspect\u00e9s ou confirm\u00e9s, les pratiques de base doivent comprendre l\u2019ajout des pr\u00e9cautions contre les gouttelettes. Des \u00c9PI suppl\u00e9mentaires sont n\u00e9cessaires contre ces s\u00e9cr\u00e9tions respiratoires lorsque le travailleur est \u00e0 moins de deux m\u00e8tres du patient pr\u00e9sentant des sympt\u00f4mes d\u2019infection respiratoire aigu\u00eb, pour \u00e9viter le d\u00e9p\u00f4t de gouttelettes ou a\u00e9rosols sur les muqueuses du membre du personnel. La Sant\u00e9 publique \u00e9num\u00e8re les proc\u00e9dures qui pr\u00e9sentent un risque accru de production et de transmission d\u2019a\u00e9rosols, tout en reconnaissant que le degr\u00e9 de risque peut \u00eatre influenc\u00e9 par le patient, l\u2019op\u00e9rateur et l\u2019environnement. Les proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols doivent \u00eatre limit\u00e9es \u00e0 celles qui sont m\u00e9dicalement n\u00e9cessaires et planifi\u00e9es, si possible, et se d\u00e9rouler dans des chambres individuelles, avec la personne la plus exp\u00e9riment\u00e9e pour effectuer la proc\u00e9dure.<\/p>\n

[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.20.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_text_color=\u00a0\u00bb#ffffff\u00a0\u00bb header_3_text_color=\u00a0\u00bb#FFFFFF\u00a0\u00bb header_5_text_color=\u00a0\u00bb#FFFFFF\u00a0\u00bb background_color=\u00a0\u00bb#81AC50″ custom_padding=\u00a0\u00bb35px|35px|35px|35px|true|true\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n

Responsabilit\u00e9 professionnelle :<\/strong><\/h5>\n

Nous reconnaissons que ces pr\u00e9cautions peuvent \u00eatre quelque chose de nouveau pour plusieurs membres de l\u2019OTRO, mais nous avons appris lors de la pand\u00e9mie de COVID-19 qu\u2019une vigilance en mati\u00e8re de pr\u00e9vention des infections est vitale pour assurer un environnement s\u00e9curitaire pour nos patients comme pour nous-m\u00eames. Avec la menace des infections respiratoires et d\u2019autres pathog\u00e8nes \u00e9mergents, il faut absolument que les th\u00e9rapeutes respiratoires autoris\u00e9s suivent les pratiques exemplaires sur la pr\u00e9vention des infections recommand\u00e9es par le MSSLD.[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text admin_label=\u00a0\u00bbtitle\u00a0\u00bb _builder_version=\u00a0\u00bb4.20.0″ header_font_size=\u00a0\u00bb45px\u00a0\u00bb custom_margin=\u00a0\u00bb||10px|\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n

Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols (suite)
\n<\/strong><\/h2>\n

[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.20.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]Il existe des interventions pour lesquelles on a confirm\u00e9 la transmission d\u2019agents infectieux par des gouttelettes ou des a\u00e9rosols. Dans d\u2019autres cas, la transmission pourrait \u00eatre possible, mais n\u2019a pas encore \u00e9t\u00e9 prouv\u00e9e. Le tableau ci-dessous illustre \u00e0 quelle cat\u00e9gorie bon nombre de proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols appartiennent.[\/et_pb_text][et_pb_code _builder_version=\u00a0\u00bb4.16″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]\n\n\n\n\t\n\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols pour lesquelles il existe des
\npreuves de transmission
\n<\/strong><\/th>		Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosols pour lesquelles il n\u2019existe pas de preuves de transmission<\/strong><\/th>\n<\/tr>\n<\/thead>\n
Intubation endotrach\u00e9ale<\/strong><\/td>Th\u00e9rapies avec n\u00e9bulisation<\/td>\n<\/tr>\n
R\u00e9animation cardiopulmonaire (RcP)<\/strong><\/td>Oscillation \u00e0 haute fr\u00e9quence (HFOV)<\/td>\n<\/tr>\n
Bronchoscopie*<\/strong><\/td>Insertion, changement et (ou) soin de trach\u00e9otomie<\/td>\n<\/tr>\n
Induction d\u2019expectoration*<\/strong><\/td>Physioth\u00e9rapie respiratoire<\/td>\n<\/tr>\n
Ventilation \u00e0 pression positive non invasive pour insuffisance respiratoire aigu\u00eb (p. ex., cPAP, BiPAP)
\n<\/strong><\/td>		Pr\u00e9l\u00e8vements et (ou) aspirations naso-pharyng\u00e9s
\n<\/td>\n<\/tr>\n
Oxyg\u00e9noth\u00e9rapie \u00e0 d\u00e9bit \u00e9lev\u00e9
\n
\n<\/strong><\/td>		Insertion de drain ou d\u2019aiguille thoracique<\/td>\n<\/tr>\n
Aspiration des voies respiratoires (ouverture artificielle, comme une trach\u00e9otomie). Utiliser une aspiration ferm\u00e9e si possible.<\/strong><\/td>Aspiration ouverte (bouche ou nez)<\/td>\n<\/tr>\n
Tests de fonction pulmonaire et spirom\u00e9trie * <\/strong><\/td><\/td>\n<\/tr>\n
<\/td>Autres bris \u00e0 l\u2019int\u00e9grit\u00e9 d\u2019un syst\u00e8me de ventilation m\u00e9canique (p. ex., changements de filtre)<\/td>\n<\/tr>\n
\"\"<\/td>\"\"<\/td>\n<\/tr>\n
* S\u2019il s\u2019agit d\u2019une bronchoscopie ou une
\ninduction d\u2019expectoration de diagnostic
\n(et non de traitement), il faut porter un
\nrespirateur N95, en raison du risque de
\ntuberculose non diagnostiqu\u00e9e (CCPMI,
\n2012b, p. 16)
\n<\/td>		\u00c9valuer les risques afin de d\u00e9cider de l\u2019\u00c9PI
\n
\nTous les chariots d\u2019urgence et de d\u00e9partement
\ndoivent comprendre ce qui suit :
\n\u2022 Un ballon de r\u00e9animation manuel avec
\nfiltre ultra-micron \u00e0 caract\u00e8re hydrophobe
\n\u2022 Cath\u00e9ters d\u2019aspiration en ligne
\n\u2022 Masque sans r\u00e9inspiration permettant la
\nfiltration des gaz expir\u00e9s
\n\u2022 \u00c9PI (gants, blouse, masque, protection oculaire)
\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n[\/et_pb_code][et_pb_text _builder_version=\u00a0\u00bb4.20.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]*En tant que document \u00e9volutif, le tableau ci-dessus est susceptible d\u2019\u00eatre modifi\u00e9 au fur et \u00e0 mesure de la mise \u00e0 jour et de la r\u00e9vision des lignes directrices de sant\u00e9 publique. Les th\u00e9rapeutes respiratoires doivent proc\u00e9der \u00e0 une \u00e9valuation des risques pour d\u00e9terminer les \u00c9PI.[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1″ _builder_version=\u00a0\u00bb4.16″ saved_tabs=\u00a0\u00bball\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.16″ background_size=\u00a0\u00bbinitial\u00a0\u00bb background_position=\u00a0\u00bbtop_left\u00a0\u00bb background_repeat=\u00a0\u00bbrepeat\u00a0\u00bb animation_style=\u00a0\u00bbflip\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.16″ custom_padding=\u00a0\u00bb|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb custom_padding__hover=\u00a0\u00bb|||\u00a0\u00bb][et_pb_toggle title=\u00a0\u00bbR\u00c9F\u00c9RENCES\u00a0\u00bb admin_label=\u00a0\u00bbGLOSSARY\u00a0\u00bb _builder_version=\u00a0\u00bb4.16″ global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n

Association for the Advancement of Medical Instrumentation (AAMI). (2015). FDA proposes new criteria for surgical gowns.<\/em> Tir\u00e9 de Association for the Advancement of Medical Instrumentation, site Web : www.aami.org\/newsviews\/newsdetail.aspx?ItemNumber=2650<\/a><\/p>\n

Institut canadien pour la s\u00e9curit\u00e9 des patients. (Aucune date.). Pneumonie associ\u00e9e au ventilateur (PAV). <\/em>Tir\u00e9 du site Web de l\u2019Institut canadien pour la s\u00e9curit\u00e9 des patients : www.patientsafetyinstitute.ca\/en\/topic\/pages\/ventilator-associatedpneumonia-(vap).aspx<\/a><\/p>\n

Centers for Disease Control and Prevention. (2011). Central line-associated bloodstream infections: Resources for patients and healthcare providers.<\/em> Tir\u00e9 du site Web de Centers for Disease Control and Prevention : www.cdc.gov\/HAI\/bsi\/CLABSI-resources.html<\/a><\/p>\n

Secr\u00e9tariat des soins aux malades en phase critique (2012). Trousse d\u2019outils de pr\u00e9vention de la <\/em>pneumonie acquise sous ventilation m\u00e9canique et les infections par cath\u00e9ter central.<\/em> Tir\u00e9 du site Web de Services ontariens des soins aux malades en phase critique : www.criticalcareontario.ca\/EN\/Toolbox\/Performance%20Improvement%20Collaborative\/VAP%20and%2 0CLI%20Toolkit%20(2012).pdf<\/a><\/p>\n

Immunize Canada. (2016). ImmunizeCA app.<\/em> Tir\u00e9 du site Web d\u2019Immunisation Canada : http:\/\/immunize.ca\/en\/app.aspx<\/a><\/p>\n

Loeb, M., Dafoe, N., Mahony J., John, M., Sarabia, A., Glavin, V., Walter, S.S. (2009). Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial.<\/em> JAMA, 302(17), 1865- 1871. doi:10.1001\/jama.2009.1466. Tir\u00e9 de http:\/\/jama.jamanetwork.com\/article.aspx?articleid=184819<\/a><\/p>\n

CCPMI. (2012a). Pratiques exemplaires \u2013 Programmes de pr\u00e9vention et de contr\u00f4le des infections en Ontario <\/em>(3e<\/sup><\/span> \u00e9dition).<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/BP_IPAC_Ontario_HCSettings_2012.pdf<\/a><\/p>\n

CCPMI. (2012b). Pratiques de base et pr\u00e9cautions suppl\u00e9mentaires dans tous les \u00e9tablissements de soins de <\/em>sant\u00e9 (3e<\/sup><\/span> \u00e9dition).<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/RPAP_All_HealthCare_Settings_Eng2012.pdf<\/a><\/p>\n

CCPMI. (2013). Annexe B : Pratiques exemplaires en mati\u00e8re de pr\u00e9vention de la transmission des infections <\/em>aigu\u00ebs des voies respiratoires dans tous les \u00e9tablissements de soins de sant\u00e9.<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/CCPMI-IPC_Annex_B_Prevention_Transmission_ARI_2013.pdf<\/a><\/p>\n

CCPMI. (2014). Pratiques exemplaires d\u2019hygi\u00e8ne des mains dans tous les \u00e9tablissements de soins de <\/em>sant\u00e9, (4e<\/sup><\/span> \u00e9dition).<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/2010-12%20BP%20Hand%20Hygiene.pdf<\/a><\/p>\n

CCPMI. (2015a). Pratiques exemplaires de pr\u00e9vention, de surveillance et de contr\u00f4le des nouvelles infections <\/em>respiratoires dans tous les \u00e9tablissements de soins de sant\u00e9.<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : http:\/\/www.publichealthontario.ca\/en\/eRepository\/Best_Practices_Novel_Respiratory_Infections.pdf<\/a><\/p>\n

CCPMI. (2015b). Pr\u00e9vention et contr\u00f4le des infections pour la pratique en cabinet et en clinique.<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/IPAC_Clinical_Office_Practice_2013.pdf<\/a><\/p>\n

CCPMI. (2016). Pr\u00e9paratifs : Triage, d\u00e9pistage et gestion des patients ayant une infection au Coronavirus du <\/em>syndrome respiratoire du Moyen-Orient (MERS-CoV) dans les \u00e9tablissements de soins actifs.<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/eRepository\/CCPMI-IPC_Preparedness_Tools_MERS_CoV_2013.pdf<\/a><\/p>\n

Agence de la sant\u00e9 publique du Canada. (2013). Guide canadien d\u2019immunisation.<\/em> Tir\u00e9 du site Web de Agence de la sant\u00e9 publique du Canada : http:\/\/phac-aspc.gc.ca\/publicat\/cig-gci\/p03-work-travail-fra.php#a1<\/a><\/p>\n

Agence de la sant\u00e9 publique du Canada. (2014). Normes canadiennes pour <\/em>la lutte antituberculeuse (7e<\/sup><\/span> \u00e9dition).<\/em> Tir\u00e9 du site Web de Agence de la sant\u00e9 publique du Canada : https:\/\/www.canada.ca\/content\/dam\/phac-aspc\/migration\/phac-aspc\/tbpc-latb\/pubs\/tb-canada-7\/assets\/pdf\/tb-standards-tb-normes-ch7-fra.pdf<\/a><\/p>\n

Agence de la sant\u00e9 publique du Canada. (2016). R\u00e9sum\u00e9 de l\u2019\u00e9valuation du risque associ\u00e9 au coronavirus du <\/em>syndrome respiratoire du Moyen-Orient (MERS-CoV) pour la sant\u00e9 publique au Canada.<\/em> Tir\u00e9 du site Web de l\u2019Agence de la sant\u00e9 publique du Canada : www.phac-aspc.gc.ca\/eri-ire\/coronavirus\/risk_assessment-evaluation_risque-fra.php<\/a><\/p>\n

Sant\u00e9 publique Ontario. (n.d.a). Cha\u00eene de transmission et \u00e9valuation des risques : Glossaire.<\/em> Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : www.publichealthontario.ca\/fr\/LearningAndDevelopment\/OnlineLearning\/InfectiousDiseases\/IPACCore\/Documents\/CORE_Trainers_COT_and_RA_Module_Glossary_April_2014.pdf<\/a><\/p>\n

Sant\u00e9 publique Ontario. (n.d.b). Algorithme des risques guidant l\u2019utilisation des \u00c9PI. Tir\u00e9 du site Web de Sant\u00e9 publique Ontario : file:\/\/\/C|\/Users\/carso\/AppData\/Local\/Temp\/ www.publichealthontario.ca\/fr\/eRepository\/IPAC_Clinical_Office_Practice_Risk_Algorithm_PPE_2013.pdf<\/a><\/p>\n

Organisation mondiale de la Sant\u00e9. (2015). Coronavirus du syndrome respiratoire du Moyen-Orient (MERSCoV). Tir\u00e9 du site Web de l\u2019Organisation mondiale de la Sant\u00e9 : www.who.int\/mediacentre\/factsheets\/mers-cov\/fr\/<\/a><\/p>\n

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Proc\u00e9dures respiratoires g\u00e9n\u00e9rant des a\u00e9rosolsDes pr\u00e9cautions doivent \u00eatre prises pour r\u00e9duire le niveau de production d\u2019a\u00e9rosols. L\u2019\u00e9valuation des risques doit \u00eatre effectu\u00e9e sur le lieu o\u00f9 sont prodigu\u00e9s les soins. 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