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Bachmann E, Zellmer S, Kahn M, Muzalyova A, Ebigbo A, Al-Nawas B, Ziebart T, Meisgeier A, Traidl-Hoffmann C, Eckstein F, Messmann H, Schlittenbauer T, Römmele C. One year of COVID-19 pandemic: Health care workers' infection rates and economical burden in medical facilities for oral and maxillofacial surgery. J Craniomaxillofac Surg 2022; 50:831-836. [PMID: 36402637 PMCID: PMC9637287 DOI: 10.1016/j.jcms.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/26/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to create an overview on the COVID-associated burdens faced by the oral and maxillofacial surgery (OMS) workforce during 1 year of the pandemic. OMS hospitals and private practices nationwide were surveyed regarding health care worker (HCW) screening, infection status, pre-interventional testing, personal protective equipment (PPE), and economic impact. Participants were recruited via the German Society for Oral and Maxillofacial Surgery. A total of 11 hospitals (416 employees) and 55 private practices (744 employees) participated. The HCW infection rate was significantly higher in private practices than in clinics (4.7% vs. 1.4%, p<0.01), although most infections in HCW occurred in private environment (hospitals 88.2%, private practice 66.7%). Pre-interventional testing was performed significantly less for outpatients in private practices than in hospitals (90.7% vs. 36.4%, p<0.01). Polymerase chain reaction (PCR) was used significantly more for inpatients in hospitals than in private practices (100.0% vs. 27.3%, p<0.01). FFP2/3 use rose significantly in hospitals (0% in second quarter vs. 46% in fourth quarter, p<0.05) and private practices (15% in second quarter vs. 38% in fourth quarter, p<0.01). The decrease in procedures (≤50%) was significantly higher in hospitals than in private practices (90.9% vs. 40.0%, p<0.01). Despite higher infection rates in private practices, declining procedures and revenue affected hospitals more. Future COVID-related measures must adjust the infrastructure especially for hospitals to prevent further straining of staff and finances.
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Affiliation(s)
- Ella Bachmann
- Department of Oral and Maxillofacial Surgery, University Hospital Augsburg, Sauerbruchstraße 6, 86179, Augsburg, Germany,Corresponding author. Department of Oral and Maxillofacial Surgery, University Hospital Augsburg – Sauerbruchstraße 6, 86179, Augsburg, Germany
| | - Stephan Zellmer
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Maria Kahn
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Anna Muzalyova
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
| | - Axel Meisgeier
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Neusäßer Straße 47, 86156, Augsburg, Germany
| | - Fabian Eckstein
- Department of Oral and Maxillofacial Surgery, University Hospital Hannover, Hannover, Germany
| | - Helmut Messmann
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery, University Hospital Augsburg, Sauerbruchstraße 6, 86179, Augsburg, Germany
| | - Christoph Römmele
- Department of Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era. J Clin Med 2021; 10:jcm10040587. [PMID: 33557273 PMCID: PMC7915471 DOI: 10.3390/jcm10040587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.
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Testori T, Wang HL, Basso M, Bordini G, Dian A, Vitelli C, Miletic I, Del Fabbro M. COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses. Acta Stomatol Croat 2020; 54:431-441. [PMID: 33642607 PMCID: PMC7871429 DOI: 10.15644/asc54/4/10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol. SOURCES AND METHODS Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed. CONCLUSION The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.
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Affiliation(s)
- Tiziano Testori
- Department of Implantology and Oral Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Dental Clinic, Director Prof. L. Francetti, Milan, Italy
| | - Hom-Lay Wang
- Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Matteo Basso
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | | | - Arturo Dian
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | - Carlo Vitelli
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | - Ivana Miletic
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000, Zagreb, Croatia
| | - Massimo Del Fabbro
- IRCCS Istituto Ortopedico Galeazzi, Dental Clinic, Milan, Italy. Associate Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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DiCaro MV, Mintz J, Shir S, Muse A, Richards J, Shah A, Farber S. Facial Surgery in the Era of SARS-CoV-2 and Beyond: Challenges, Considerations, and Initiatives. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3301. [PMID: 33299727 PMCID: PMC7722594 DOI: 10.1097/gox.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
The SARS-CoV-2 pandemic resulted in the implementation of healthcare practice regulations and restrictions across the United States. To facilitate safe patient management practices for facial plastic and reconstructive surgeons, appropriate guidelines and recommendations should be followed. Guidelines and recommendations should include a synthesis of the best evidence available from public health authorities and respected members in the surgery community. This review contains evidence-based suggestions that prioritize the safety of healthcare professionals and patients to help guide facial and reconstructive surgeons toward safe patient management.
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Affiliation(s)
| | - Joel Mintz
- College of Allopathic Medicine, Nova Southeastern University, Davie, Fla
| | - Shirzad Shir
- College of Medicine Tucson, University of Arizona, Tucson, Ariz
| | - Andrew Muse
- College of Medicine Tucson, University of Arizona, Tucson, Ariz
| | - Joseph Richards
- College of Medicine Tucson, University of Arizona, Tucson, Ariz
| | - Amita Shah
- Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center San Antonio, Tex
| | - Scott Farber
- Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center San Antonio, Tex
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Wang CJ, Hoffman GR, Walton GM. The Implementation of COVID-19 Social Distancing Measures Changed the Frequency and the Characteristics of Facial Injury: The Newcastle (Australia) Experience. Craniomaxillofac Trauma Reconstr 2020; 14:150-156. [PMID: 33995836 DOI: 10.1177/1943387520962280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Study Design A retrospective study was undertaken of a cohort of facially injured patients using matched 8-week periods: non-COVID (2019) and COVID (2020). Objective To determine whether there were any changes to the frequency and characteristics of facial injury due to the imposition of COVID-19 social distancing measures. Methods The primary predictor variable was an 8-week period of COVID-19 social distancing. The primary outcome variable was the sustaining of a facial injury. Demographic (age/gender) and injury characteristics (mechanism, site, and treatment) were also studied. Descriptive statistical analysis was undertaken and comparison made using Pearson χ2 and Fisher's exact tests. Results The number of facial injuries decreased from 103 (2019) to 73 (2020). There were statistically significant differences in changes over time for the 8-week periods. There were some clinically apparent differences seen in the characteristics of facial injuries. Conclusions The imposition of COVID-19 social distancing changed the frequency and characteristics of facial injury.
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Affiliation(s)
- Che-Jen Wang
- Department of Maxillofacial Surgery, John Hunter Hospital, Newcastle, Australia
| | - Gary R Hoffman
- Department of Maxillofacial Surgery, John Hunter Hospital, Newcastle, Australia.,Medical School, University of Newcastle, Newcastle, Australia
| | - Gary M Walton
- University Hospital Coventry and Warwickshire NHS Trust, Walsgrave Hospital Coventry, Coventry, UK
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