1
|
Sheng T, Wu X, Cen L, Lu Y, Zhou C, Gu Q. Potential effects of aerosol generation and transmission during bedside endoscope cleaning. J Zhejiang Univ Sci B 2024; 25:628-632. [PMID: 39011682 PMCID: PMC11254679 DOI: 10.1631/jzus.b2300552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/06/2023] [Indexed: 07/17/2024]
Abstract
Airborne transmission is among the most frequent types of nosocomial infection. Recent years have witnessed frequent outbreaks of airborne diseases, such as severe acute respiratory syndrome (SARS) in 2002, Middle East respiratory syndrome (MERS) in 2012, and coronavirus disease 2019 (COVID-19), with the latter being on the rampage since the end of 2019 and bringing the effect of aerosols on health back to the fore (Gralton et al., 2011; Wang et al., 2021). An increasing number of studies have shown that certain highly transmissible pathogens can maintain long-term stability and efficiently spread through aerosols (Leung, 2021; Lv et al., 2021). As reported previously, influenza viruses that can spread efficiently through aerosols remain stable for a longer period compared to those that cannot. The World Health Organization (WHO) has stated that aerosol-generating procedures (AGPs) play an important role in aerosol transmission in hospitals (Calderwood et al., 2021). AGPs, referring to medical procedures that produce aerosols, including dental procedures, endotracheal intubation, sputum aspiration, and laparoscopic surgeries, have been reported to be significantly associated with an increased risk of nosocomial infection among medical personnel (Hamilton, 2021).
Collapse
Affiliation(s)
- Tingting Sheng
- Nursing Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xin Wu
- Nursing Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li Cen
- Department of Gastroenterology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ye Lu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Chenying Zhou
- Nursing Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qing Gu
- Nursing Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| |
Collapse
|
2
|
Makino M, Takesue Y, Murakami Y, Morosawa M, Doi M, Ogashiwa H, Ueda T, Nakajima K, Sugiura H, Nozaki Y. Influence of easing COVID-19 strategies following downgrading of the national infectious disease category on COVID-19 occurrence among hospitalized patients in Japan. J Infect Chemother 2024:S1341-321X(24)00182-X. [PMID: 38977074 DOI: 10.1016/j.jiac.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/20/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE We aimed to evaluate the influence of easing COVID-19 preventive measures following its downgrading to a common infectious disease on COVID-19 occurrence among hospitalized patients. METHODS Nosocomial occurrence of COVID-19 was compared between periods with national infectious disease category 5 versus the preceding category 2 equivalent. Changes in the revised manual included a shorter duration of work restrictions for infected health care practitioners (HCPs); no work restriction for HCPs exposed to SARS-CoV-2 with a negative test on days 1, 3 and 5; discontinuation of universal pre-admission screening; and pre-emptive isolation of patients without screening. Wearing an N95 mask and face shield was required in procedure/care with moderate-to high-risk contact. RESULTS Although the mean monthly number of infected HCPs increased from 8.1 to 12.7 in the category 5 period (p = 0.034) and that of pre-admission screening decreased to one-fourth, the COVID-19 incidence in hospitalized patients remained similar between the two study periods (1.60 ± 5.59/month versus 1.40 ± 2.63/month, p = 0.358). Clusters, defined as ≥3 COVID-19 patients on the ward, were experienced twice in the preceding period and only once in the category 5 period. The index cases causing nosocomial SARS-CoV-2 transmission mostly involved rehabilitation therapists in the preceding period; five of six index cases were patients in the category 5 period. Following the expanded indication for N95 masks, neither SARS-CoV-2 transmission to patients nor transmission from infected patients was observed in HCPs for 1 year. CONCLUSION With sustained, enhanced standard precautions, easing prevention strategies could limit nosocomial SARS-CoV-2 infections.
Collapse
Affiliation(s)
- Miyuki Makino
- Department of Infection Prevention and Control, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan; Department of Infection Prevention and Control, Hyogo Medical University Hospital, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Prevention and Control, Hyogo Medical University Hospital, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Prevention and Control, Hyogo Medical University Hospital, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroyuki Sugiura
- Department of Rehabilitation, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| |
Collapse
|
3
|
Kadanthode M, Chaudhary Z, Sharma P, Mohanty S, Sharma C. Single Institute Audit of Maxillofacial Trauma Cases Before and During COVID-19 Pandemic. Craniomaxillofac Trauma Reconstr 2023; 16:102-111. [PMID: 37222976 PMCID: PMC10201186 DOI: 10.1177/19433875211064514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design In the year 2020, we saw the emergence of severe acute respiratory syndrome coronavirus 2 causing COVID-19 into a full blown pandemic. This resulted in constraints on healthcare resources, and the attention was shifted to reduce cross contamination and prevent spreader events. Maxillofacial trauma care was also affected similarly, and most of the cases were managed by closed reduction whenever possible. A retrospective study was conducted to document our experience in treating maxillofacial trauma cases before and after nationwide lockdown due to COVID-19 pandemic in India. Objective The objective of the study was to compare the effect of pandemic in reported pattern of mandibular trauma and the result of closed reduction procedures in the management of single or multiple fractures in mandible during this time period. Methods The study was conducted in the Department of Oral and Maxillofacial Surgery, Maulana Azad institute of Dental Sciences, Delhi, for a period of 20 months, that is, 10 months before and after nationwide lock down which was effective from 23rd March 2020 due to COVID-19 pandemic. The cases were grouped into Group A (those reporting from 1st June 2019 to 31st March 2020) and Group B (those reporting from 1st April 2020 to 31st January 2021). Primary objectives were assessed and compared according to etiology, gender, location of the mandibular fractures, and treatment provided. Quality of life (QoL) associated with the treatment outcome by closed reduction was assessed after 2 months as a secondary objective using General Oral Health Assessment Index (GOHAI) in Group B. Results A total of 798 patients sought treatment for mandibular fractures and included 476 patients in Group A and 322 in Group B. The groups showed similar age and male: female ratio. Cases showed a steep fall during first wave of pandemic, and most of the cases occurred as result of RTA followed by fall and assault. The fractures due to fall and assault showed an obvious rise during the lockdown period. There were 718 (89.97%) patients having exclusive mandibular fractures and 80 (10.03%) patients having involvement of both mandible and maxilla. Single fractures of mandible constituted 110 (23.11%) and 58 (18.01%) in Group A and B, respectively. 324 patients (68.07%) and 226 patients (70.19%) had multiple fractures involving mandible in respective groups. Parasymphysis of mandible was most commonly involved (24.31%) followed closely by unilateral condyle (23.48%) then Angle and Ramus of mandible (20.71%) with coronoid being the least fractured. During the initial 6 months after lockdown, all the cases were treated successfully using closed reduction. GOHAI QoL assessment conducted in cases having exclusive mandibular fracture (210 Multiple, 48 Single) showed favorable results with significant (P < .05) difference between the single and multiple fractures. Conclusions After one and half years and recovering from the second wave of pandemic that hit the country, we have come to understand COVID-19 better and embraced better management protocol. The study reveals that IMF remains the gold standard for the management of most of the facial fractures in pandemic situations. It was evident from the QoL data that most of the patients were able to carry out their day-to-day functions adequately. As the country prepares for a third wave of pandemic, management of maxillofacial trauma by closed reduction will remain the norm for most unless indicated otherwise.
Collapse
Affiliation(s)
- Mithilesh Kadanthode
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Zainab Chaudhary
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Pankaj Sharma
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Sujata Mohanty
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Chayanika Sharma
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| |
Collapse
|
4
|
Zhang Q, Zhao L, Qi G, Zhang X, Tian C. Raman and fourier transform infrared spectroscopy techniques for detection of coronavirus (COVID-19): a mini review. Front Chem 2023; 11:1193030. [PMID: 37273513 PMCID: PMC10232992 DOI: 10.3389/fchem.2023.1193030] [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: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Coronavirus pandemic has been a huge jeopardy to human health in various systems since it outbroke, early detection and prevention of further escalation has become a priority. The current popular approach is to collect samples using the nasopharyngeal swab method and then test for RNA using the real-time polymerase chain reaction, which suffers from false-positive results and a longer diagnostic time scale. Alternatively, various optical techniques, namely, optical sensing, spectroscopy, and imaging shows a great promise in virus detection. In this mini review, we briefly summarize the development progress of vibrational spectroscopy techniques and its applications in the detection of SARS-CoV family. Vibrational spectroscopy techniques such as Raman spectroscopy and infrared spectroscopy received increasing appreciation in bio-analysis for their speediness, accuracy and cost-effectiveness in detection of SARS-CoV. Further, an account of emerging photonics technologies of SARS-CoV-2 detection and future possibilities is also explained. The progress in the field of vibrational spectroscopy techniques for virus detection unambiguously show a great promise in the development of rapid photonics-based devices for COVID-19 detection.
Collapse
Affiliation(s)
- Qiuqi Zhang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lei Zhao
- Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, College of Chemistry and Chemical Engineering, Linyi University, Linyi, China
| | - Guoliang Qi
- Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, College of Chemistry and Chemical Engineering, Linyi University, Linyi, China
| | - Xiaoru Zhang
- Key Laboratory of Optic-Electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis and College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Qingdao, China
| | - Cheng Tian
- Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, College of Chemistry and Chemical Engineering, Linyi University, Linyi, China
| |
Collapse
|
5
|
Sultan S. Gastrointestinal Endoscopy in Patients with Coronavirus Disease 2019: Indications, Findings, and Safety. Gastroenterol Clin North Am 2023; 52:157-172. [PMID: 36813423 PMCID: PMC9678816 DOI: 10.1016/j.gtc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed the practice of gastroenterology and how we perform endoscopy. As with any new or emerging pathogen, early in the pandemic, there was limited evidence and understanding of disease transmission, limited testing capability, and resource constraints, especially availability of personal protective equipment (PPE). As the COVID-19 pandemic progressed, enhanced protocols with particular emphasis on assessing the risk status of patients and proper use of PPE have been incorporated into routine patient care. The COVID-19 pandemic has taught us important lessons for the future of gastroenterology and endoscopy.
Collapse
Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
| |
Collapse
|
6
|
Gohli J, Brantsæter AB, Bøifot KO, Grub C, Granerud BK, Holter JC, Riise AMD, Smedholen MF, Dybwad M. SARS-CoV-2 in the Air Surrounding Patients during Nebulizer Therapy. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:9297974. [PMID: 36213437 PMCID: PMC9536972 DOI: 10.1155/2022/9297974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022]
Abstract
Nebulizer therapy is commonly used for patients with obstructive pulmonary disease or acute pulmonary infections with signs of obstruction. It is considered a "potential aerosol-generating procedure," and the risk of disease transmission to health care workers is uncertain. The aim of this pilot study was to assess whether nebulizer therapy in hospitalized COVID-19 patients is associated with increased dispersion of SARS-CoV-2. Air samples collected prior to and during nebulizer therapy were analyzed by RT-PCR and cell culture. Total aerosol particle concentrations were also quantified. Of 13 patients, seven had quantifiable virus in oropharynx samples, and only two had RT-PCR positive air samples. For both these patients, air samples collected during nebulizer therapy had higher SARS-CoV-2 RNA concentrations compared to control air samples. Also, for particle sizes 0.3-5 µm, particle concentrations were significantly higher during nebulizer therapy than in controls. We were unable to cultivate virus from any of the RT-PCR positive air samples, and it is therefore unknown if the detected virus were replication-competent; however, the significant increase in smaller particles, which can remain airborne for extended periods of time, and increased viral RNA concentrations during treatment may indicate that nebulizer therapy is associated with increased risk of SARS-CoV-2 transmission.
Collapse
Affiliation(s)
- Jostein Gohli
- Norwegian Defence Research Establishment, P. O. Box 25, No. 2027 Kjeller, Oslo, Norway
| | - Arne Broch Brantsæter
- Department of Infectious Diseases, Oslo University Hospital, P. O. Box 4956, Nydalen, No. 0424, Oslo, Norway
- Norwegian National Unit for CBRNE Medicine, Oslo University Hospital, P. O. Box 4956, Nydalen, No. 0424, Oslo, Norway
| | - Kari Oline Bøifot
- Norwegian Defence Research Establishment, P. O. Box 25, No. 2027 Kjeller, Oslo, Norway
- Department of Analytics, Environmental & Forensic Sciences, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Carola Grub
- Institute of Microbiology, Norwegian Armed Forces Joint Medical Services, P. O. Box 25, No. 2027, Kjeller, Oslo, Norway
| | - Beathe Kiland Granerud
- Department of Microbiology, Oslo University Hospital, P. O. Box 4950, Blindern, No. 0424, Oslo, Norway
- Department of Nursing, Health and Laboratory Science, University College of Østfold, P. O. Box 700, No. 1757, Halden, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P. O. Box 1171, Blindern, No. 0318, Oslo, Norway
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, P. O. Box 4950, Blindern, No. 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P. O. Box 1171, Blindern, No. 0318, Oslo, Norway
| | - Anne Margarita Dyrhol Riise
- Department of Infectious Diseases, Oslo University Hospital, P. O. Box 4956, Nydalen, No. 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P. O. Box 1171, Blindern, No. 0318, Oslo, Norway
| | | | - Marius Dybwad
- Norwegian Defence Research Establishment, P. O. Box 25, No. 2027 Kjeller, Oslo, Norway
- Department of Analytics, Environmental & Forensic Sciences, King's College London, 150 Stamford Street, London SE1 9NH, UK
| |
Collapse
|
7
|
Dong L, Li WF, Jiang Y. Performance evaluation of antigen detection rapid diagnostic test (Ag-RDT) for COVID-19 diagnosis in a primary healthcare center during the Shanghai COVID-19 quarantine period. Virol J 2022; 19:140. [PMID: 36050725 PMCID: PMC9434095 DOI: 10.1186/s12985-022-01871-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rapid and accurate detection of SARS-CoV-2 infection is the cornerstone of prompt patient care. However, the reliability of the antigen rapid diagnostic test (Ag-RDT) in the diagnosis of SARS-CoV-2 infection remains inconclusive. METHODS We conducted a field evaluation of Ag-RDT performance during the Shanghai Coronavirus disease 2019 (COVID-19) quarantine and screened 7225 individuals visiting our Emergency Department. 83 asymptomatic SARS-CoV-2 (+) individuals were enrolled in the current study. Simultaneously, Ag-RDT was performed to evaluate its testing performance. RESULTS For the Ag-RDT(-) cases, the average cycle threshold (Ct) values of the N gene were 27.26 ± 4.59, which were significantly higher than the Ct value (21.9 ± 4.73) of the Ag-RDT(+) individuals (p < 0.0001). The overall sensitivity of Ag-RDT versus that of RT-PCR was 43.37%. The Ag-RDT(+) individuals regarding the N gene's Ct value were 16 cases in the < 20 range, 12 in 20-25, 5 in 25-30, and 3 in 30-35. The corresponding sensitivity was 84.21%, 52.17%, 21.74% and 16.67%, respectively. Meanwhile, sampling had a straight specificity of 100% regardless of the Ct value. CONCLUSIONS The Ag-RDT were extremely sensitive in asymptomatic COVID-19 individuals with a Ct value < 20.
Collapse
Affiliation(s)
- Lan Dong
- Department of Emergency Department, Shanghai Chang Zheng Hospital, Shanghai, People's Republic of China
| | - Wen-Fang Li
- Department of Emergency Department, Shanghai Chang Zheng Hospital, Shanghai, People's Republic of China
| | - Ying Jiang
- Department of Neurosurgery, Shanghai Chang Zheng Hospital, Shanghai, People's Republic of China.
- Cerebrovascular Diseases Center, Department of Neurosurgery, Renji Hospital, Shanghai, People's Republic of China.
| |
Collapse
|
8
|
Chan KKP, Hui DSC. Contemporary Concise Review 2021: COVID-19 and other respiratory infections. Respirology 2022; 27:661-668. [PMID: 35670259 PMCID: PMC9347613 DOI: 10.1111/resp.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
Bats are likely the primary source of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Minks are highly susceptible to infection by SARS‐CoV‐2. Transmission from asymptomatic individuals was estimated to account for over 50% of all transmissions of coronavirus disease 2019 (COVID‐19) cases. SARS‐CoV‐2 is evolving towards more efficient aerosol transmission. Remdesivir, baricitinib, tocilizumab and dexamethasone are frequently used for the treatment of patients with respiratory failure due to COVID‐19. There is a rising incidence of non‐tuberculous Mycobacterium pulmonary disease globally, with a higher prevalence in Asian countries than in the Western world. Protracted bacterial bronchitis is a common cause of chronic productive cough in childhood. Re‐emergence of respiratory syncytial virus may occur after the relaxation of infection control measures and the reopening of borders during COVID‐19 pandemic.
Collapse
Affiliation(s)
- Ken K P Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - David S C Hui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| |
Collapse
|
9
|
LaRiviere MJ, Shah YB, Cummings ER, Clegg K, Doucette A, Struyk BP, Lustig RA, Kurtz G, Hill-Kayser CE. General Anesthesia for Pediatric Radiotherapy in the Era of COVID-19. Adv Radiat Oncol 2022; 7:100929. [PMID: 35280349 PMCID: PMC8898088 DOI: 10.1016/j.adro.2022.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Managing pediatric patients requiring daily general anesthesia (GA) for radiation therapy (RT) in the setting of COVID-19 is complex, owing to the aerosolizing nature of GA procedures, the risk of cardiopulmonary complications for infected patients, and the treatment of immunocompromised oncology patients in a busy, densely populated radiation oncology clinic. Methods and Materials We developed an institutional protocol to define procedures for COVID-19 testing and protection of patients, caregivers, and staff, hypothesizing that this protocol would allow patients requiring GA to be safely treated, minimizing COVID-19 transmission risk to both patients and staff, and at the same time maintaining pre–COVID-19 patient volumes. All patients underwent COVID-19 testing before their first treatment and thrice weekly during treatment. For patients who tested positive for COVID-19, RT was delivered in the last end-of-day treatment appointment. A negative pressure room was used for GA induction and recovery, and separate physician/nurse teams were designated for in-room versus out-of-room patient management. Results Seventy-eight pediatric patients received RT under GA, versus 69 over the same prior year timeframe, and 2 patients received 2 courses of RT under GA, for a total of 80 courses. The mean age was 4.9 years (range, 0.5-19.0 years) and 41 of 78 (52.6%) were male. Two patients (2.6%) received 2 courses of RT under GA, establishing a total of 80 courses. The mean number of treatment fractions was 22.2 (range, 1-40). Two of 78 patients (2.6%) tested positive for COVID-19; both were asymptomatic. Both patients completed treatment as prescribed. Neither patient developed cardiopulmonary symptoms complicating anesthesia, and neither patient experienced grade 3+ acute radiation toxicity. Conclusions With careful multidisciplinary planning to mitigate COVID-19 risk, pediatric RT with GA was carried out for a large patient volume without widespread infection and without increased toxic effects from either GA or RT.
Collapse
|
10
|
Doyle R, Bate S, Devenney J, Agwaonye S, Hastings M, Wych J, Archbold S, Vasant DH. Evaluating the impact of an enhanced triage process on the performance and diagnostic yield of oesophageal physiology studies post COVID-19. BMJ Open Gastroenterol 2021; 8:e000810. [PMID: 34933867 PMCID: PMC8692781 DOI: 10.1136/bmjgast-2021-000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic significantly impacted on the provision of oesophageal physiology investigations. During the recovery phase, triaging tools were empirically recommended by national bodies for prioritisation of referrals amidst rising waiting lists and reduced capacity. We evaluated the performance of an enhanced triage process (ETP) consisting of telephone triage combined with the hierarchical 'traffic light system' recommended in the UK for prioritising oesophageal physiology referrals. DESIGN In a cross-sectional study of patients referred for oesophageal physiology studies at a tertiary centre, data were compared between patients who underwent oesophageal physiology studies 6 months prior to the COVID-19 pandemic and those who were investigated within 6 months after service resumption with implementation of the ETP. OUTCOME MEASURES Adjusted time from referral to investigation; non-attendance rates; the detection of Chicago Classification (CC) oesophageal motility disorders on oesophageal manometry and severity of acid reflux on 24 hours pH/impedance monitoring. RESULTS Following service resumption, the ETP reduced non-attendance rates from 9.1% to 2.8% (p=0.021). Use of the 'traffic light system' identified a higher proportion of patients with CC oesophageal motility disorders in the 'amber' and 'red' triage categories, compared with the 'green' category (p=0.011). ETP also reduced the time to test for those who were subsequently found to have a major CC oesophageal motility diagnosis compared with those with minor CC disorders and normal motility (p=0.004). The ETP did not affect the yield or timing of acid reflux studies. CONCLUSION ETPs can effectively prioritise patients with oesophageal motility disorders and may therefore have a role beyond the current pandemic.
Collapse
Affiliation(s)
- Rebecca Doyle
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sebastian Bate
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Jade Devenney
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sophia Agwaonye
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Margaret Hastings
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jane Wych
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sharon Archbold
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| |
Collapse
|
11
|
Occupational Health and Safety Measures in Healthcare Settings during COVID-19: Strategies for Protecting Staff, Patients and Visitors. Disaster Med Public Health Prep 2021; 17:e48. [PMID: 34517932 PMCID: PMC8523969 DOI: 10.1017/dmp.2021.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of healthcare systems worldwide, placing the health and safety of frontline healthcare workers at risk, and it still continues to remain an important public health challenge. Several hospitals have put in place strategies to manage space, staff, and supplies in order to continue to deliver optimum care to patients while at the same time protecting the health and safety of staff and patients. However, the emergence of the second and third waves of the virus with the influx of new cases continue to add an additional level of complexity to the already challenging situation of containing the spread and lowering the rate of transmission, thus pushing healthcare systems to the limit. In this narrative review paper, we describe various strategies including administrative controls, environmental controls, and use of personal protective equipment, implemented by occupational health and safety departments for the protection of healthcare workers, patients, and visitors from SARS-CoV-2 virus infection. The protection and safeguard of the health and safety of healthcare workers and patients through the implementation of effective infection control measures, adequate management of possible outbreaks and minimization of the risk of nosocomial transmission is an important and effective strategy of SARS-CoV-2 pandemic management in any healthcare facility. High quality patient care hinges on ensuring that the care providers are well protected and supported so they can provide the best quality of care to their patients.
Collapse
|