Aerosol production during autopsies: The risk of sawing in bone

Pluim, Jip; Jimenez-Bou, Lucas; Gerretsen, Reza; Loeve, Arjo J.

doi:10.1016/j.forsciint.2018.05.046

Cited by 25 publications

(34 citation statements)

References 23 publications

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“…Fourth, in these same cases, oscillating saws were not used, to comply with CDC recommendations and in line with studies showing that their use generates fine, respirable particles which may serve to deliver virus to the respiratory tract of personnel. 20 Fifth, in persons under investigation (swab-negative), the autopsy was targeted to structures of particular interest to avoid dispersion of potentially hazardous fluids around the morgue in the case of a false-negative result. Sixth, chest blocks, and lungs in particular, were perfused with 10% formalin prior to further examination (lung being further perfused via bronchi after removal with formalin in a steel pan).…”

Section: Resultsmentioning

confidence: 99%

Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

et al. 2020

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Pathology training programs throughout the United States have endured unprecedented challenges dealing with the ongoing coronavirus disease 2019 pandemic. At Houston Methodist Hospital, the Department of Pathology and Genomic Medicine planned and executed a trainee-oriented, stepwise emergency response. The focus was on optimizing workflows among areas of both clinical and anatomic pathology, maintaining an excellent educational experience, and minimizing trainee exposure to coronavirus disease 2019. During the first phase of the response, trainees were divided into 2 groups: one working on-site and the other working remotely. With the progression of the pandemic, all trainees were called back on-site and further redeployed within our department to meet the significantly increased workload demands of our clinical laboratory services. Adjustments to trainee educational activities included, among others, the organization of a daily coronavirus disease 2019 virtual seminar series. This series served to facilitate communication between faculty, laboratory managers, and trainees. Moreover, it became a forum for trainees to provide updates on individual service workflows and volumes, ongoing projects and research, as well as literature reviews on coronavirus disease 2019–related topics. From our program’s experience, redeploying pathology trainees within our department during the coronavirus disease 2019 pandemic resulted in optimization of patient care while ensuring trainee safety, and importantly, helped to maintain continuous high-quality education through active involvement in unique learning opportunities.

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Section: Resultsmentioning

confidence: 99%

Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

et al. 2020

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“…As another step to minimize the generation of aerosols, we tried to use the power saw at the lower frequency and to maintain the saw blade contact load to a maximum level. Pluim JME et al reported that higher saw frequency and low saw blade contact load led to higher production of aerosols [25]. Judicial use of an electrocautery (lower effective power, used with suction device to minimize the surgical smoke) and use of feeding tube as irrigation and suction cannula in place of pulse lavage system were others steps to minimize the production of aerosols during the procedure.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic and total knee arthroplasty: the concept of a containment sheet—a frugal innovation

et al. 2020

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Background: The primary purpose of the present study was to assess whether use of proposed containment sheet (so called "a frugal innovation") minimizes the aerosol and splatter dispersion during total knee arthroplasty (TKA). Material and method: A total of 32 patients with knee osteoarthritis who were scheduled to undergo primary and unilateral TKA reported during the COVID-19 pandemic were enrolled into this prospective single-institution cohort study. Demographic and epidemiological data, travel and contact history were collected. Eligible cohort was randomly assigned to a study (TKA using containment sheet) group and a control group (TKA without containment sheet). Radiological and functional outcomes before operation and at the final follow-up were assessed using Western Ontario and Mc-master Universities Osteoarthritis Index score (WOMAC) and the visual analog scale (VAS). The primary outcome was the postoperative effectiveness of containment sheet and face shield, defined as the numbers of countable macroscopic aerosols and/or splatters to naked eyes. The level of significance was set at p < 0.05 levels. Results: Present cohort was comprised of 14 men (43.75%) and 18 women (56.25%) with an average age of 65.45 ± 4.07 years (range, 62-75 years). There were no statistically significant differences with regard to baseline parameters and perioperative demographics. Functional outcomes for knee function at the last follow-up showed significant improvement in both the groups (p < 0.05). Face shield showed significant number of aerosols/splatters in control group. Highest number/concentration of aerosols/splatters was contained within the sheet. Conclusion: The proposed containment sheet can minimize the dispersion of aerosols and splatters generated during TKA and provide a safe healthcare environment in a cost-effective manner.

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“…A prior pilot study was performed on the influence of saw blade frequency and saw blade contact load on the production of aerosol in dry bone [12]. For the current study three additional parameters were selected that closely represent the variety in sawing parameters faced in daily practice.…”

Section: Methodsmentioning

confidence: 99%

“…Effects were considered significant when p ≤ 0.05. A more detailed description of the methodology can be found in our previously published research [14].…”

Section: Methodsmentioning

confidence: 99%

Minimizing aerosol bone dust during autopsies

Pluim

Loeve

Gerretsen

2019

Forensic Sci Med Pathol

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When sawing bone for medical or medico-legal procedures, fine, airborne dust is produced (aerosols) that can pose a health hazard when inhaled. The aim of this study was to determine the influence of saw blade frequency and contact load, bone condition, test environment, and saw blade type, on the production of aerosol particles. A custom test setup was designed, manufactured and used in 8 bone sawing experiments, using a particle counter to determine the production of aerosol particles while varying the 5 chosen parameters. The number of counted particles was highest with higher saw blade frequencies, lower saw blade contact loads, in dry completely skeletonized bone compared to fresh bone, and using an electrical oscillating saw compared to hand-sawing. Under all conditions, the high amount of aerosol counted posed potential health risks. The ventilation system that we tested was adequate in removing the produced particles, but these high-tech systems are not always available in developing countries or emergency situations. The production of aerosols can be reduced by optimizing the sawing parameters. However, even the lowest number of aerosol particles counted during the current study was high enough to cause potential health risks to practitioners. Safety precautions should be taken, such as external ventilation, proper breathing gear, and adequate protocols, to truly minimize the risk in all bone sawing scenarios.

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Aerosol production during autopsies: The risk of sawing in bone

Cited by 25 publications

References 23 publications

Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

COVID-19 pandemic and total knee arthroplasty: the concept of a containment sheet—a frugal innovation

Minimizing aerosol bone dust during autopsies

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