Figure - uploaded by Hamza Mbareche
Content may be subject to copyright.
Source publication
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 infectio...
Contexts in source publication
Context 1
... of 32 patients had a repeat nasopharyngeal swab closer to the date of their procedure (median 3, mean 5.1, range 0-24 d). Twenty of the 332 (6%) samples tested positive for SARS-CoV-2 RNA (Table 2 [detailed table provided ...Citations
... Three studies informed about the method used to seal the samples. One used ziploc plastic bag (Lee et al., 2022) and 2 insulated boxes (Pasalari et al., 2019(Pasalari et al., , 2022. ...
... 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. ...
... The survey also included questions about whether any COVID-19 symptoms were experienced after the patient encounter, any COVID-19 testing they undertook after the procedure, and their vaccination status. The same survey was distributed in 2021 to HCWs who participated in an earlier study 14 14 . The HCW survey results from different groups of HCWs (e.g. ...
... The survey also included questions about whether any COVID-19 symptoms were experienced after the patient encounter, any COVID-19 testing they undertook after the procedure, and their vaccination status. The same survey was distributed in 2021 to HCWs who participated in an earlier study 14 14 . The HCW survey results from different groups of HCWs (e.g. ...
Introduction
The Omicron variant of the SARS-CoV-2 virus is described as more contagious than previous variants. We sought to assess risk to healthcare workers (HCWs) caring for patients with COVID-19 in surgical/obstetrical settings, and the perception of risk amongst this group.
Methods
From January to April, 2022, reverse transcription polymerase chain reaction was used to detect the presence of SARS-CoV-2 viral RNA in patient, environmental (floor, equipment, passive air) samples, and HCW’s masks (inside surface) during urgent surgery or obstetrical delivery for patients with SARS-CoV-2 infection. The primary outcome was the proportion of HCWs’ masks testing positive. Results were compared with our previous cross-sectional study involving obstetrical/surgical patients with earlier variants (2020/21). HCWs completed a risk perception electronic questionnaire.
Results
11 patients were included: 3 vaginal births and 8 surgeries. 5/108 samples (5%) tested positive (SARS-CoV-2 Omicron) viral RNA: 2/5 endotracheal tubes, 1/22 floor samples, 1/4 patient masks and 1 nasal probe. No samples from the HCWs masks (0/35), surgical equipment (0/10) and air samples (0/11) tested positive. No significant differences were found between the Omicron and 2020/21 patient groups’ positivity rates (Mann-Whitney U test, p = 0.838) or the level of viral load from the nasopharyngeal swabs (p = 0.405). Nurses had a higher risk perception than physicians (p = 0.038).
Conclusion
No significant difference in contamination rates were found between SARS-CoV-2 Omicron BA.1 and previous variants in surgical/obstetrical settings. This is reassuring as no HCW mask was positive and no HCW tested positive for COVID-19 post-exposure.
... 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. ...
Given the high transmissibility of SARS‐CoV‐2 as witnessed early in the COVID‐19 pandemic, concerns arose with the existing methods for virus disinfection and decontamination. The need for SARS‐CoV‐2‐specific data stimulated considerable research in this regard. Overall, SARS‐CoV‐2 is practically and equally susceptible to approaches for disinfection and decontamination that have been previously found for other human or animal coronaviruses. The latter have included techniques utilizing temperature modulation, pH extremes, irradiation, and chemical treatments. These physicochemical methods are a necessary adjunct to other prevention strategies given the environmental and patient surface ubiquity of virus. Classic studies of disinfection have also allowed for extrapolation to the eradication of virus on human mucosal surfaces with some chemical means. Despite considerable laboratory study, practical field assessments are generally lacking and need to be encouraged in order to confirm the correlation of interventions with viral eradication and infection prevention. Transparency in the constitution and use of any method or chemical is also essential to furthering practical applications. This article is protected by copyright. All rights reserved.
Background
Healthcare workers in obstetric clinics may be exposed to airborne SARS-CoV-2 when treating patients with COVID-19.
Method
In this study, performed during the midst of the pandemic, air samples were collected in delivery rooms during childbirth and analysed for SARS-CoV-2 RNA content.
Result
Six of 28 samples collected inside delivery rooms were positive for SARS-CoV-2, but none in anterooms or corridors. Five of the six positive samples were from the same occasion.
Discussion
This indicates that some patients could be major sources of exhaled virus, although the individual variation is large, and it is thus difficult to predict the risk of infection.
The efficacy of face masking for the public is not convincing to prevent the transmission of respiratory tract viruses such as SARS-CoV-2 when the criteria of evidence-based medicine are applied. This finding is mainly explained by the results from randomized-controlled trials (RCTs) when a high prevalence of the infection and a high compliance in mask wearing was assured. Throughout these studies no significant protective effect was observed. Observational studies with surgical masks describe a significant protective effect, but are prone to confounders such as physical distance. Respirators do not provide an additional health benefit compared to surgical or medical masks (RCTs). Community masks can even increase the risk of infection (RCTs). Based on the categories of evidence-based medicine, the efficacy results can best be categorized as conflicting evidence. Many relevant adverse events are described when masks are worn for hours such as dyspnea (12.2–52.8%), headache (3.9–73.4%), pruritus (0.0–60.0%), and skin reactions (0.0–85.0%). Their frequency is often higher with respirators. In future pandemics, masks should only be recommended or mandated for settings in which a clinically relevant health benefit can be expected, defined as the prevention of severe, critical or fatal disease, that clearly outweighs the expectable associated adverse reactions.
Background
SARS-CoV-2 has changed global healthcare since the pandemic began in 2020. The safety of minimally invasive surgery (MIS) utilizing insufflation from the standpoint of safety to the operating room personnel is currently being explored. The aims of this guideline are to examine the existing evidence to provide guidance regarding MIS for the patient with, or suspecting of having, the SARS-CoV-2 as well as the healthcare team involved.
Methods
Systematic literature reviews were conducted for 2 key questions (KQ) regarding the safety of MIS in the setting of COVID-19 pandemic. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. Evidence-based recommendations were formulated using a narrative synthesis of the literature by subject experts. Recommendations for future research were also proposed.
Results
In KQ1, a total of 1361 articles were reviewed, with 2 articles meeting inclusion. In KQ2, a total of 977 articles were reviewed, with 4 articles met inclusions criteria, of which 2 studies reported on the SARS-CoV2 virus specifically. Despite many publications in the field, very little well-controlled and unbiased data exist to inform the recommendations. Of that which is available, it shows that both laparoscopic and open operations in Covid-positive patients had similar rates of OR staff positivity rates; however, patients who underwent laparoscopic procedures had a lower perioperative mortality than open procedures. Also, SARS-CoV-2 particles have been detected in the surgical plume at laparoscopy.
Conclusion
With demonstrated equivalence of operating room staff exposure, and noninferiority of laparoscopic access with respect to mortality, either laparoscopic or open approaches to abdominal operations may be used in patients with SARS-CoV-2. Measures should be employed for all laparoscopic or open cases to prevent exposure of operating room staff to the surgical plume, as virus can be present in this plume.
