New dimensions in airway management: risks for healthcare staff

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Microbial contamination of powered air purifying respirators (PAPR) used by healthcare staff during the COVID-19 pandemic: an in situ microbiological study

Background

Powered air purifying respirators (PAPR) are an option for healthcare workers requiring respiratory protection during the current COVID-19 pandemic; they are shared between multiple people. PAPR hoods are intended for multiple uses by a single user and may pose an infection risk between wearers.

Methods

Internal components of PAPR hoods and corrugated air supply hoses were swabbed for evidence of bacterial, fungal, common respiratory viruses and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) contamination.

Results

Twenty-five PAPR hoods were swabbed; 10 (40%) returned positive results. Bacterial growth was detected on six PAPR; five of the PAPR tested positive for fungal growth; all tested negative for SARS-CoV-2 and common respiratory viruses.

Conclusions

Bacteria and fungi can remain on internal components of PAPR hoods and air supply hoses despite following recommended disinfection procedures. PAPR hoods have the potential to act as fomites, cross-infecting wearers, and patients. Current guidelines for disinfecting PAPR hoods may not be effective for use in high risk healthcare environments.