Detection of SARS-CoV-2 contamination in the operating room and birthing room setting: a cross-sectional study

Abstract

Background: The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers. Methods: We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers’ masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties). Results: A total of 32 patients (age 20–88 yr) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic or trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20 of 332 (6%) patient and environmental samples collected: 4 of 24 (17%) patient samples, 5 of 60 (8%) floor samples, 1 of 54 (2%) air samples, 10 of 23 (43%) surgical instrument or equipment samples, 0 of 24 cautery filter samples and 0 of 143 (95% confidence interval 0–0.026) inner surface of mask samples. Interpretation: During the study period of November 2020 to May 2021, we found evidence of SARS-CoV-2 RNA in a small but important number of samples obtained in the surgical and obstetric operative environment. The finding of no detectable virus inside the masks worn by the health care teams would suggest a low risk of infection for health care workers using appropriate personal protective equipment.

Disinfection and decontamination in the context of SARS‐CoV‐2‐specific data

“…Although early studies at times proposed that SARS‐CoV‐2 was sparsely found in the patient environment, the ubiquity of the environmental presence of the virus in contiguity to the infected patient soon became more obvious 1 . There has been a plethora of investigations since that corroborate the common environmental presence at least of viral RNA 19–36 . These positive determinations have included caregiver garments and accessories.…”

“…These positive determinations have included caregiver garments and accessories. Flooring is often underappreciated for contamination 32,33,36,37 . Diagnostic equipment may also be a common site for virus contamination 34 .…”

“… 1 There has been a plethora of investigations since that corroborate the common environmental presence at least of viral RNA. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 These positive determinations have included caregiver garments and accessories. Flooring is often underappreciated for contamination.…”

“…Flooring is often underappreciated for contamination. 32 , 33 , 36 , 37 Diagnostic equipment may also be a common site for virus contamination. 34 Nevertheless, there is likely to be considerable variability in the degree of environmental or protective gear soiling with virus, given the heterogeneity of home, societal, and hospital environments.…”

Evaluation of real and perceived risk to health care workers caring for patients with the Omicron variant of the SARS-CoV-2 virus in surgery and obstetrics

“…However, the risk of HCWs contracting Omicron variant of the SARS-CoV-2 through respiratory droplets in an obstetrical or surgical setting is unclear. Besides the respiratory tract, the SARS-CoV-2 virus has also been shown to be present in the GI tract, amniotic fluid, peritoneal fluid and vaginal fluid [8][9][10][11][12][13][14] . For surgeries/procedures that involve these structures or substances, the risk of transmission through aerosolization of viral particles from the surgical site is unclear.…”