Italian doctors call for protecting healthcare workers and boosting community surveillance during covid-19 outbreak

Purpose With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. UK) for consideration in the presented practice recommendations. Results World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. Conclusion Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosolgenerating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. Level of evidence IV.

show abstract

“…The European FFP3, equivalent to the US N99, is recommended for aerosol protection against COVID- 19 (Figs. 3,4).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

Hirschmann

Hart

Henckel

et al. 2020

Knee Surg Sports Traumatol Arthrosc

194

218

View full text Add to dashboard Cite

show abstract

“…However, the duration of MV in our study tended to be the same or longer than that in previous studies. In a retrospective case series of 1000 patients in New York, the median duration of MV in patients who survived was 9 (6.5-12) days [3], and another multicentre cohort study of 2215 patients in New York reported that the median duration of MV in patients who survived was 13 (9)(10)(11)(12)(13)(14) days [41]. The median duration of MV for patients in the current study was 13 (IQR, 10-16) days.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in patients with COVID-19, intubation is a high-risk procedure because of aerosol generation [9]. In Italy, healthcare workers comprised 9% of total COVID-19 patients [10]. Respiratory therapists, intubation providers, and bedside nurses are at highest risk [11].…”

Section: Introductionmentioning

confidence: 99%

Extubation success without using high-flow nasal cannula and non-invasive ventilation for patients with coronavirus disease 2019 (COVID-19): A retrospective observational study

Inoue¹,

Shirakawa²,

Fujita³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) to be a global pandemic. It was also reported that approximately 20%-23% of patients with COVID-19 admitted to the hospital required mechanical ventilation (MV). Reintubation rates ranged from 13–19%, leading to increased mortality. Moreover, exposure of health care workers is a serious problem and intubation is a high-risk procedure because of aerosol generation. To reduce reintubation, preventive high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) after extubation are recommended. However, using HFNC and NIV in patients with COVID-19 may lead to the spread of infection. Without using HFNC and NIV, conventional spontaneous breathing trial (SBT) may overestimate a patient’s respiratory status. A highly demanding SBT accurately assesses a patient’s reserve capacity and may reduce reintubation. We did not use preventive HFNC or NPPV and extubated with a highly demanding SBT protocol. This study aimed to evaluate whether our protocol can be performed safely.Methods This single-centre study was conducted at the Kawasaki Municipal Hospital from February 2020 to June 2020. Patients with COVID-19 requiring MV were screened for their eligibility for the weaning procedure every day. Patients were extubated after administering methylprednisolone if SBT was well tolerated. SBT was performed with 3 cmH2O pressure support, 3 cmH2O positive end-expiratory pressure, and ≤ 0.30 fraction of inspired oxygen. In extubated patients, the reintubation rate, duration of MV, length of intensive care unit (ICU) and hospital stay, and rate of ventilator-associated pneumonia (VAP) were analyzed.Results Ten patients received MV. Two of 10 patients had no improvement in their respiratory status and did not qualify for the extubation criteria and died. Eight patients were extubated. No reintubations were performed (0%). The median durations of MV, ICU stay, and hospital stay were 13 (interquartile range [IQR], 10–16) days, 17 (IQR, 13–27) days, and 22 (IQR, 16–26), and 3 patients (37.5%) was diagnosed VAP.Conclusions Extubation was performed with a highly demanding SBT protocol, and no patients were reintubated. All patients did not require HFNC and NIV. Further research is required in critically ill patients.

show abstract

“…Our results predict that Sweden's healthcare capacity (both for COVID-19 patients and for others) will be rapidly overwhelmed under the current strategy, both through the need to care for COVID-19 patients and because healthcare workers will themselves become ill and unable to work. [41][42][43][44][45][46][47][48][49] Intensive care capacity is projected to become a particular bottleneck, as shown in other countries. [50][51][52] For Sweden, this is in particular worrisome considering the relatively low availability of beds prior to the pandemic compared to other European countries 22 24 and recent reports challenging Swedish disaster preparedness.…”

Section: Meaning Of the Study: Possible Explanations And Implicationsmentioning

confidence: 99%

Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

Wijngaart

Gardner

Willem

et al. 2020

Preprint

View full text Add to dashboard Cite

Objectives: During March 2020, the COVID-19 pandemic has rapidly spread globally, and non-pharmaceutical interventions are being used to reduce both the load on the healthcare system as well as overall mortality. Design: Individual-based transmission modelling using Swedish demographic and Geographical Information System data and conservative COVID-19 epidemiological parameters. Setting: Sweden Participants: A model to simulate all 10.09 million Swedish residents. Interventions: 5 different non-pharmaceutical public-health interventions including the mitigation strategy of the Swedish government as of 10 April; isolation of the entire household of confirmed cases; closure of schools and non-essential businesses with or without strict social distancing; and strict social distancing with closure of schools and non-essential businesses. Main outcome measures: Estimated acute care and intensive care hospitalisations, COVID-19 attributable deaths, and infections among healthcare workers from 10 April until 29 June. Findings: Our model for Sweden shows that, under conservative epidemiological parameter estimates, the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000). The most stringent public-health measures examined are predicted to reduce mortality by approximately three-fold. Intensive-care load at the peak could be reduced by over two-fold with a shorter period at peak pandemic capacity. Conclusions: Our results predict that, under conservative epidemiological parameter estimates, current measures in Sweden will result in at least 40-fold over-subscription of pre-pandemic Swedish intensive care capacity, with 15.8 percent of Swedish healthcare workers unable to work at the pandemic peak. Modifications to ICU admission criteria from international norms would further increase mortality.

show abstract

Italian doctors call for protecting healthcare workers and boosting community surveillance during covid-19 outbreak

Cited by 93 publications

References 4 publications

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

Extubation success without using high-flow nasal cannula and non-invasive ventilation for patients with coronavirus disease 2019 (COVID-19): A retrospective observational study

Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

Contact Info

Product

Resources

About