Operative team checklist for aerosol generating procedures to minimise exposure of healthcare workers to SARS-CoV-2

Soma, Marlene; Jacobson, Ian; Brewer, Jessica; Blondin, Angela; Davidson, G; Singham, Shamani

doi:10.1016/j.ijporl.2020.110075

Cited by 26 publications

(30 citation statements)

References 21 publications

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“…Results reflect the concerns with the laparoscopic approach and the risks of viral aerosolization. In our study, only 26% had performed laparoscopic procedures [49]. The low level of reported preoperative COVID-19 screening (32%) is of serious concern, and efforts should be made to perform some screening for all emergency surgical cases.…”

Section: Discussionmentioning

confidence: 69%

International cooperation group of emergency surgery during the COVID-19 pandemic

Benítez

Ribeiro

Alexandrino

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. Methods Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. Results One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. Conclusion Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.

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Section: Discussionmentioning

confidence: 69%

International cooperation group of emergency surgery during the COVID-19 pandemic

Benítez

Ribeiro

Alexandrino

et al. 2020

Eur J Trauma Emerg Surg

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“…4,48 Precautions must be taken to prevent exposure to aerosolized particles by streamlining care and increasing efficiency via timeouts and checklists ( Table 2). [49][50][51][52][53]…”

Section: Aerosol-generating Proceduresmentioning

confidence: 99%

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Meister

Pandian

Hillel

et al. 2020

Otolaryngol.--head neck surg.

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Objective In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.

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“…CT scan of the thorax should be routinely performed in case of laryngotracheobronchial foreign body in children [22]. CT scan of the thorax is highly sensitive and specific to confirm the foreign body in the airway and minimize the negative bronchoscopy rates [23]. If the child is clinically unstable or with stridor, he should be shifted to the operating room (OR) with full precautions and PPE.…”

Section: Pre-operative Testingmentioning

confidence: 99%

“…Pediatric patients of sinusitis with orbital cellulitis can be recommended for surgery. The sinonasal pathology threatening the vision or resulting in intracranial complications should be planned for endoscopic sinus surgery [23,24]. An external approach can be adopted because of the high viral load in the nasal cavity.…”

Section: Pediatric Endoscopic Sinus Surgerymentioning

confidence: 99%

“…In case of the endoscopic sinus surgery, throat pack should be given with caution as the insertion of the throat pack has chance of producing aerosols, however, the secretions of the pharynx may stimulate the coughing during emergency from anesthesia. The nasal bone fracture of the pediatric patient should not be recommended in this current pandemic time unless there is association with nasal septal hematoma [23].…”

Section: Pediatric Endoscopic Sinus Surgerymentioning

confidence: 99%

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Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic – A real challenge to the clinicians

Swain¹,

Behera²

2020

Indian J Child Health

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evere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent for the outbreak of the coronavirus disease (COVID-19), started in Wuhan, China, since late December 2019 [1]. SARS-CoV-2 was earlier known as the 2019 novel coronavirus (2019-nCoV), an enveloped singlestranded RNA virus [1]. The otolaryngologists have an important role as health-care providers for examining the patients with otorhinolaryngological manifestations. There are concerns for a greater number of the asymptomatic pediatric patients infected with COVID-19 [2]. The pediatric patients often present with diseases related to the upper airway such as sinonasal infections, tonsillitis, pharyngitis, nasal foreign body, airway foreign body, otitis media, and adenoid infections. There are disproportionately a high number of clinicians, infected with COVID-19 during their patient care specifically the pediatric age group [3]. This infection spreads mainly through the respiratory airway by droplets, secretions, and direct contact [4]. Examination and procedure in otolaryngology patients involve upper aerodigestive areas which are high risk for viral transmission, making the pediatric otolaryngologist the most vulnerable healthcare professionals. At present, the risk of the viral transmission from the asymptomatic pediatric patients with COVID-19 to the health care workers is often difficult to assess on the basis of the clinical evaluation. The asymptomatic pediatric patients present high chance of the viral shedding during the clinical examination or any surgical procedure on the nose, paranasal sinuses, oral cavity, and laryngopharyngeal region and transmit these infections to the clinicians and assisting team members [5]. The COVID-19 pandemic requires careful assessment of the pediatric patients specifically before any otorhinolaryngological intervention such as laryngotracheobronchial airway, sinonasal tract, oral cavity, and otological procedures. METHODS OF THE LITERATURE SEARCH Research articles regarding managing pediatric otorhinolaryngology patients in COVID-19 pandemic were searched through multiple approaches. First, we conducted an online search of the PubMed, Scopus, Google Scholar, and Medline databases with the word pediatric otorhinolaryngology patients, COVID-19 pandemic, flexible nasopharyngolaryngoscopy in pediatric patients, pediatric tracheostomy, pediatric endoscopic sinus surgery, pediatric mastoid surgery, and hearing screening of the pediatric patients in current COVID-19 pandemic. A search strategy using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was developed. Randomized

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Operative team checklist for aerosol generating procedures to minimise exposure of healthcare workers to SARS-CoV-2

Cited by 26 publications

References 21 publications

International cooperation group of emergency surgery during the COVID-19 pandemic

International cooperation group of emergency surgery during the COVID-19 pandemic

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic – A real challenge to the clinicians

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