Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri‐operative care: a narrative review

Schutzer-Weissmann, John; Magee, David J.; Farquhar-Smith, Paul

doi:10.1111/anae.15221

Cited by 6 publications

(4 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The extent to which SARS-CoV-2 is transmitted by the airborne route is a controversial topic [3][4][5][6]. Aerosolised particles (typically considered to be < 20 µm in diameter and particularly those of < 5 µm) may transmit infection by deposition on respiratory epithelium and can potentially transit the full extent of the respiratory tract.…”

Section: Introductionmentioning

confidence: 99%

A quantitative evaluation of aerosol generation during tracheal intubation and extubation

et al. 2020

View full text Add to dashboard Cite

Summary The potential aerosolised transmission of severe acute respiratory syndrome coronavirus‐2 is of global concern. Airborne precaution personal protective equipment and preventative measures are universally mandated for medical procedures deemed to be aerosol generating. The implementation of these measures is having a huge impact on healthcare provision. There is currently a lack of quantitative evidence on the number and size of airborne particles produced during aerosol‐generating procedures to inform risk assessments. To address this evidence gap, we conducted real‐time, high‐resolution environmental monitoring in ultraclean ventilation operating theatres during tracheal intubation and extubation sequences. Continuous sampling with an optical particle sizer allowed characterisation of aerosol generation within the zone between the patient and anaesthetist. Aerosol monitoring showed a very low background particle count (0.4 particles.l −1 ) allowing resolution of transient increases in airborne particles associated with airway management. As a positive reference control, we quantitated the aerosol produced in the same setting by a volitional cough (average concentration, 732 (418) particles.l −1 , n = 38). Tracheal intubation including facemask ventilation produced very low quantities of aerosolised particles (average concentration, 1.4 (1.4) particles.l −1 , n = 14, p < 0.0001 vs. cough). Tracheal extubation, particularly when the patient coughed, produced a detectable aerosol (21 (18) l −1 , n = 10) which was 15‐fold greater than intubation (p = 0.0004) but 35‐fold less than a volitional cough (p < 0.0001). The study does not support the designation of elective tracheal intubation as an aerosol‐generating procedure. Extubation generates more detectable aerosol than intubation but falls below the current criterion for designation as a high‐risk aerosol‐generating procedure. These novel findings from real‐time aerosol detection in a routine healthcare setting provide a quantitative methodology for risk assessment that can be extended to other airway management techniques and clinical settings. They also indicate the need for reappraisal of what constitutes an aerosol‐generating procedure and the associated precautions for routine anaesthetic airway management.

show abstract

Section: Introductionmentioning

confidence: 99%

A quantitative evaluation of aerosol generation during tracheal intubation and extubation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…SARS-CoV-2 is highly contagious and is primarily transmitted through breath aerosols and skin contact. Consequently, both healthcare workers and patients are at risk during surgery and interventions [ 19 , 20 ]. This has become a major problem, especially for institutions that treat COVID-19-positive patients and follow up on other patients at the same time.…”

Section: Discussionmentioning

confidence: 99%

Are surgical and non-operating room intervention safe in the COVID-19 pandemic? A retrospective study

et al. 2021

View full text Add to dashboard Cite

Little is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3% in surgical patients, 3.3% in intervention patients and 3% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4%. Only 3.3% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates.

show abstract

“…The vast impact of the pandemic necessitates an evaluation of all options to decrease spread and protect clinicians. The Association of Anesthetists discusses the need for modifications to reduce nosocomial infections citing that more than 20% of SARS-CoV-2 infections are healthcare workers [8]. Utilizing the airway box in clinical practice may decrease the risk of transmission.…”

Section: Introductionmentioning

confidence: 99%

Will Protective Innovations Like the “Airway Box” Become Routine Practice After the Pandemic?: An Opinion Survey

Ellison¹,

Nanners²,

Schaefer³

et al. 2021

Cureus

View full text Add to dashboard Cite

Background Tracheal intubation carries an elevated risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the generation of aerosols containing high concentrations of the virus. An airway box was designed to mitigate the exposure of healthcare professionals performing intubations. Aim We evaluated usability and sustainability in the routine practice of the "airway box" as a protective device during high-risk airway procedures. Materials and methods After institutional review board approval, clinicians were educated on using the device through simulation, intranet learning modules, and emailed resources. The airway box was made available in the emergency department, critical care units, perioperative area, and operating rooms. QR codes affixed to the box, emailed, and displayed in common areas provided easy access to complete a REDcap survey (Vanderbilt University Nashville, USA) eliciting providers' experience. Data was collected and analyzed between April 1 and July 31, 2020, on REDcap, and the results were analyzed. Results 687 emergent intubations took place. 232 were performed by anesthesiologists, 315 by emergency department providers, and 140 by critical care specialists. 39 surveys were completed, 29 from intubations in the operating room, three from the critical care units, five from interventional radiology suites, and two perioperatively. Providers found the device to be readily available, with a score of 4.51/5, and the majority of providers, 60%, found the device easy to use, rating it either a 4 or 5 out of 5. Providers acquired a mean Mallampati score of 1.75 and 1.40 mean laryngoscopic grade view. Conclusion Intubation boxes may effectively mitigate high-risk viral exposure during airway procedures. Survey responses show that devices were easy to use and did not significantly affect visualization of the airway. Similar to mask use, enclosure devices in clinical practice could become a vital part of medical protective equipment even after the SARS-CoV-2 pandemic if they are effectively implemented.

show abstract

Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri‐operative care: a narrative review

Cited by 6 publications

References 82 publications

A quantitative evaluation of aerosol generation during tracheal intubation and extubation

A quantitative evaluation of aerosol generation during tracheal intubation and extubation

Are surgical and non-operating room intervention safe in the COVID-19 pandemic? A retrospective study

Will Protective Innovations Like the “Airway Box” Become Routine Practice After the Pandemic?: An Opinion Survey

Contact Info

Product

Resources

About