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Khambati N, Song R, Smith JP, Bijker EM, McCarthy K, Click ES, Mchembere W, Okumu A, Musau S, Okeyo E, Perez-Velez CM, Cain K. Feasibility and utility of a combined nasogastric-tube-and-string-test device for bacteriologic confirmation of pulmonary tuberculosis in young children. Diagn Microbiol Infect Dis 2024; 109:116302. [PMID: 38657352 PMCID: PMC11128341 DOI: 10.1016/j.diagmicrobio.2024.116302] [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: 12/22/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
For microbiological confirmation of pediatric pulmonary tuberculosis (PTB), gastric aspirates (GA) are often operationally unfeasible without hospitalization, and the encapsulated orogastric string test is not easily swallowed in young children. The Combined-NasoGastric-Tube-and-String-Test (CNGTST) enables dual collection of GA and string specimens. In a prospective cohort study in Kenya, we examined its feasibility in children under five with presumptive PTB and compared the bacteriological yield of string to GA. Paired GA and string samples were successfully collected in 95.6 % (281/294) of children. Mycobacterium tuberculosis was isolated from 7.0 % (38/541) of GA and 4.3 % (23/541) of string samples, diagnosing 8.2 % (23/281) of children using GA and 5.3 % (15/281) using string. The CNGTST was feasible in nearly all children. Yield from string was two-thirds that of GA despite a half-hour median dwelling time. In settings where the feasibility of hospitalisation for GA is uncertain, the string component can be used to confirm PTB.
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Affiliation(s)
- Nisreen Khambati
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA USA; Department of Pediatrics, Harvard Medical School, Boston, MA USS
| | - Jonathan P Smith
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Department of Pediatrics, Maastricht University Medical Center, MosaKids Children's Hospital, Maastricht, the Netherlands
| | - Kimberly McCarthy
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Eleanor S Click
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Walter Mchembere
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Albert Okumu
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Susan Musau
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Elisha Okeyo
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | | | - Kevin Cain
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 PMCID: PMC11326136 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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3
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Dev AK, Gupta A, Dalai S. A Comparative Investigation of Aerosol Generation and Exposure Risk During Access Cavity Preparation With or Without Rubber Dam Application. Cureus 2024; 16:e61758. [PMID: 38975474 PMCID: PMC11226564 DOI: 10.7759/cureus.61758] [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] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Aerosols generated during dental procedures have taken the forefront of discussion in dentistry. Due to the nature of their work, dental professionals face a significant risk of exposure to various biological hazards, such as saliva, blood, aerosols, and droplets. Aerosols, which are tiny particles with a diameter of less than 50µm, have a unique property that allows them to stay suspended in the air for extended periods. This is primarily due to their small size and lightweight nature which makes them highly susceptible to air currents and prevents them from quickly settling down. As a result, these aerosols can linger in the atmosphere, creating a potential risk for respiratory infections. AIM The aim is to evaluate and compare the efficacy of rubber dams in preventing aerosols generated cross-contamination. METHODS AND MATERIAL This in-vivo experimental study comprised 60 individuals who were suggested for root canal treatment in the mandibular first permanent molar tooth. The passive air sampling technique using "settle plates" was applied to investigate microbial fallout during access opening with and without rubber dam application. Sheep blood agar plates were used to do the colony forming unit (CFU) count. All patients were randomly divided into two groups comprising 30 patients each based on usage of rubber dam application or not, i.e., Group I: Without rubber dam application and Group II: With rubber dam application. RESULTS Using a rubber dam while performing an endodontic procedure significantly impacts decreased aerosol generation at 0.5-m and 2-m distances than its counterpart with a p-value < 0.01. CONCLUSION Using a rubber dam during endodontic procedures reduces the likelihood of aerosol generation, thereby decreasing the risk of cross-contamination and lowering the susceptibility of dental professionals to respiratory illnesses.
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Affiliation(s)
- Anugeet K Dev
- Conservative Dentistry and Endodontics, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, IND
| | - Aakash Gupta
- Dentistry, All India Institute of Medical Sciences, Bathinda, Bathinda, IND
| | - Sasmita Dalai
- Dentistry, All India Institute of Medical Sciences, Bathinda, Bathinda, IND
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Duś-Ilnicka I, Paradowska-Stolarz A, Mazur M, Radwan-Oczko M, Perra A, Paula VSD, Ward LS, Valente NA, Firkova E, Karteva T, Jorda LM, Sousa Gomes PD, Dominiak M. Blended intensive programme's implementation in dental education: post-pandemic evolution of learning. BMC MEDICAL EDUCATION 2024; 24:352. [PMID: 38553736 PMCID: PMC10981333 DOI: 10.1186/s12909-024-05301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/12/2024] [Indexed: 04/01/2024]
Abstract
Blended Intensive Programmes (BIP's) represent a valuable tool for gathering knowledge and summarising the latest trends in medicine and dentistry. Blended education has been found, even before the COVID-19 pandemic, to increase the level of education and stimulate effective learning for postgraduate healthcare professionals. Interprofessional education is critical for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. This article outlines the key points of the Blended Intensive Programme's implementation in dental education organised by Wroclaw Medical University in Poland. BIP involved professors from 12 universities or research institutions from Europe and South America and 28 participants from 8 countries. The course was taught remotely and in person. In addition, it included a visit to the university and practical classes with artificial simulation and practice in dentistry. A structured questionnaire enabled measuring the evaluation of students' perception of the COVID-19 education before and after the pandemic. The European Region Action Scheme for the Mobility of University Students (ERASMUS) was fundamental to carrying out the BIP with the participation of several countries, allowing the exchange of knowledge, assessing the impact of the pandemic on dental universities, and strengthening international collaborations and the future project of research, education and clinical assistance. We conclude that hybrid teaching programmes broaden the learning spectrum in dental studies by allowing transnational and interdisciplinary approaches that make students aware of the importance of their work within the framework of the general health approach, as this differs from country to country.
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Affiliation(s)
- Irena Duś-Ilnicka
- Department of Oral Pathology, Wrocław Medical University, ul. Krakowska 26, 50-425, Wrocław, Poland.
| | - Anna Paradowska-Stolarz
- Department of Dentofacial Anomalies, Department of Orthodontics and Dentofacial Orthopedics, Wroclaw Medical University, Krakowska 26, 52-425, Wrocław, Poland
| | - Marta Mazur
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161, Rome, Italy
| | - Małgorzata Radwan-Oczko
- Department of Oral Pathology, Wrocław Medical University, ul. Krakowska 26, 50-425, Wrocław, Poland
| | - Andrea Perra
- Sezione di Patologia, Dipartimento di Scienze biomediche, Università degli Studi di Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Vanessa Salete de Paula
- Molecular Virology and Parasitology Laboratory, IOC/ Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Nicola Alberto Valente
- Division of Periodontology, School of Dental Medicine, Department of Surgical Sciences, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy
| | - Elena Firkova
- Department of Periodontology and Oral Diseases, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Teodora Karteva
- Department of Operative Dentistry and Endodontics Faculty of Dental Medicine, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Lucia Miralles Jorda
- Dentistry Department, Medical and Health Sciences Faculty, Catholic University of Valencia, Calle Quevedo, 2, 46001, Valencia, Spain
| | - Pedro de Sousa Gomes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393, Porto, Portugal
| | - Marzena Dominiak
- Oral Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425, Wroclaw, Poland
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5
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Vieira FN, Masy V, LaRue RJ, Laengert SE, De Lannoy CF, Rodrigues A, Sklar MC, Lo N, Petrosoniak A, Rezende-Neto J, Brochard LJ. An Individual Barrier Enclosure Actively Removing Aerosols for Airborne Isolation: A Vacuum Tent. Respir Care 2024; 69:395-406. [PMID: 38538026 PMCID: PMC11108102 DOI: 10.4187/respcare.11094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND Aerosol barrier enclosure systems have been designed to prevent airborne contamination, but their safety has been questioned. A vacuum tent was designed with active continuous suctioning to minimize risks of aerosol dispersion. We tested its efficacy, risk of rebreathing, and usability on a bench, in healthy volunteers, and in an ergonomic clinical assessment study. METHODS First, a manikin with airway connected to a breathing simulator was placed inside the vacuum tent to generate active breathing, cough, and CO2 production; high-flow nasal cannula (HFNC) was applied in the manikin's nares. Negative pressure was applied in the vacuum tent's apex port using wall suction. Fluorescent microparticles were aerosolized in the vacuum tent for qualitative assessment. To quantify particles inside and around vacuum tent (aerosol retention), an airtight aerosol chamber with aerosolized latex microparticles was used. The vacuum tent was tested on healthy volunteers breathing with and without HFNC. Last, its usability was assessed in 5 subjects by 5 different anesthesiologists for delivery of full anesthesia, including intubation and extubation. RESULTS The vacuum tent was adjusted until no leak was visualized using fluorescent particles. The efficacy in retaining microparticles was confirmed quantitatively. CO2 accumulation inside the vacuum tent showed an inverse correlation with the suction flow in all conditions (normal breathing and HFNC 30 or 60 L/min) in bench and healthy volunteers. Particle removal efficacy and safe breathing conditions (CO2, temperature) were reached when suctioning was at least 60 L/min or 20 L/min > HFNC flow. Five subjects were successfully intubated and anesthetized without ergonomic difficulties and with minimal interference with workflow and an excellent overall assessment by the anesthesiologists. CONCLUSIONS The vacuum tent effectively minimized aerosol dispersion. Its continuous suction system set at a high suction flow was crucial to avoid the spread of aerosol particles and CO2 rebreathing.
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Affiliation(s)
- Fernando N Vieira
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Veronique Masy
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ryan J LaRue
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Scott E Laengert
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Charles F De Lannoy
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Antenor Rodrigues
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael C Sklar
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nick Lo
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew Petrosoniak
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joao Rezende-Neto
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laurent J Brochard
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
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6
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Eaton-Williams P, Williams J. 'Family members screaming for help makes it very difficult to don PPE'. A qualitative study on UK ambulance staff experiences of infection prevention and control practices during the COVID-19 pandemic. J Infect Prev 2024; 25:17-23. [PMID: 38362117 PMCID: PMC10866121 DOI: 10.1177/17571774231209494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/21/2023] [Indexed: 02/17/2024] Open
Abstract
Background During the first wave of the COVID-19 pandemic in the UK, ambulance staff continued to deliver direct patient care whilst simultaneously adapting to a considerable escalation in evolving infection prevention and control (IPC) practices. Aim To enable learning to benefit future planning, this qualitative article aims to describe ambulance staff's experiences of this rapid escalation of IPC practices. Method Three online surveys were presented during the acceleration, peak, and deceleration phases of the pandemic's first wave in the UK (2020). Overall, 18 questions contributed 14,237 free text responses that were examined using inductive thematic analysis at both descriptive and interpretive levels. Findings Many participants lacked confidence in policies related to the use of personal protective equipment (PPE) because of perceived inadequate supporting evidence, confusing communication, and low familiarity with items. Compliance with policy and confidence in PPE use were further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices within the work environment, including reducing unnecessary exposure through public education and remote triage improvements. Discussion Some participants' poor experiences of escalating IPC practices were shared with health care workers studied in other environments and in previous epidemics, emphasising the need for lessons to be learnt. PPE should be developed with consideration of ambulance staff's unique working environment and regular familiarisation training could be beneficial. Pragmatic, evidence-based, clearly communicated policies implemented with sufficient resources may protect staff and facilitate them to maintain standards of care delivery during a pandemic.
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Affiliation(s)
- Peter Eaton-Williams
- Senior Research Paramedic, South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - Julia Williams
- Professor of Paramedic Science, School of Health & Social Work, University of Hertfordshire, Hatfield, UK
- Head of Research, College of Paramedics, Bridgwater, UK
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7
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Resende ASDO, Bacci SLLDS, Paula ÍR, Pereira LA, Johnston C, Luszczynski VCN, Azevedo VMGDO. Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn? CRITICAL CARE SCIENCE 2023; 35:273-280. [PMID: 38133157 PMCID: PMC10734813 DOI: 10.5935/2965-2774.20230359-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration. METHODS An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units. RESULTS A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment. CONCLUSION Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.
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Affiliation(s)
| | - Suzi Laine Longo dos Santos Bacci
- Hospital de Clínicas de Uberlândia, Empresa
Brasileira de Serviços Hospitalares, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Ítalo Ribeiro Paula
- Hospital de Clínicas de Uberlândia, Empresa
Brasileira de Serviços Hospitalares, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Leandro Alves Pereira
- Faculdade de Matemática, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Cíntia Johnston
- Department of Pediatrics, Faculdade de Medicina, Universidade de
São Paulo - São Paulo (SP), Brazil
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8
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Doe G, Taylor SJ, Topalovic M, Russell R, Evans RA, Maes J, Van Orshovon K, Sunjaya A, Scott D, Prevost AT, El-Emir E, Harvey J, Hopkinson NS, Kon SS, Patel S, Jarrold I, Spain N, Man WDC, Hutchinson A. Spirometry services in England post-pandemic and the potential role of AI support software: a qualitative study of challenges and opportunities. Br J Gen Pract 2023; 73:e915-e923. [PMID: 37903639 PMCID: PMC10633654 DOI: 10.3399/bjgp.2022.0608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/26/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Spirometry services to diagnose and monitor lung disease in primary care were identified as a priority in the NHS Long Term Plan, and are restarting post-COVID-19 pandemic in England; however, evidence regarding best practice is limited. AIM To explore perspectives on spirometry provision in primary care, and the potential for artificial intelligence (AI) decision support software to aid quality and interpretation. DESIGN AND SETTING Semi-structured interviews with stakeholders in spirometry services across England. METHOD Participants were recruited by snowball sampling. Interviews explored the pre- pandemic delivery of spirometry, restarting of services, and perceptions of the role of AI. Transcripts were analysed thematically. RESULTS In total, 28 participants (mean years' clinical experience = 21.6 [standard deviation 9.4, range 3-40]) were interviewed between April and June 2022. Participants included clinicians (n = 25) and commissioners (n = 3); eight held regional and/or national respiratory network advisory roles. Four themes were identified: 1) historical challenges in provision of spirometry services; 2) inequity in post- pandemic spirometry provision and challenges to restarting spirometry in primary care; 3) future delivery closer to patients' homes by appropriately trained staff; and 4) the potential for AI to have supportive roles in spirometry. CONCLUSION Stakeholders highlighted historic challenges and the damaging effects of the pandemic contributing to inequity in provision of spirometry, which must be addressed. Overall, stakeholders were positive about the potential of AI to support clinicians in quality assessment and interpretation of spirometry. However, it was evident that validation of the software must be sufficiently robust for clinicians and healthcare commissioners to have trust in the process.
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Affiliation(s)
- Gillian Doe
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Richard Russell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rachael A Evans
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | | | | | - Anthony Sunjaya
- George Institute for Global Health, UNSW Sydney, Australia; George Institute for Global Health, Imperial College London, London; Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Scott
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK; Diabetes Research Centre, University of Leicester, Leicester, UK
| | - A Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Ethaar El-Emir
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; Department of Respiratory Medicine, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Jennifer Harvey
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; Department of Respiratory Medicine, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | | | - Samantha S Kon
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; Department of Respiratory Medicine, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Nanette Spain
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; National Heart & Lung Institute, Imperial College London, London; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Guy's and St Thomas' NHS Foundation Trust, London; National Heart & Lung Institute, Imperial College London, London; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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9
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Cizmic A, Eichel VM, Weidner NM, Wise PA, Müller F, Rompen IF, Bartenschlager R, Schnitzler P, Nickel F, Müller-Stich BP. Viral load of SARS-CoV-2 in surgical smoke in minimally invasive and open surgery: a single-center prospective clinical trial. Sci Rep 2023; 13:20299. [PMID: 37985848 PMCID: PMC10662446 DOI: 10.1038/s41598-023-47058-z] [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: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
At the beginning of the COVID-19 pandemic, it was assumed that SARS-CoV-2 could be transmitted through surgical smoke generated by electrocauterization. Minimally invasive surgery (MIS) was targeted due to potentially higher concentrations of the SARS-CoV-2 particles in the pneumoperitoneum. Some surgical societies even recommended open surgery instead of MIS to prevent the potential spread of SARS-CoV-2 from the pneumoperitoneum. This study aimed to detect SARS-CoV-2 in surgical smoke during open and MIS. Patients with SARS-CoV-2 infection who underwent open surgery or MIS at Heidelberg University Hospital were included in the study. A control group of patients without SARS-CoV-2 infection undergoing MIS or open surgery was included for comparison. The trial was approved by the Ethics Committee of Heidelberg University Medical School (S-098/2021). The following samples were collected: nasopharyngeal and intraabdominal swabs, blood, urine, surgical smoke, and air samples from the operating room. An SKC BioSampler was used to sample the surgical smoke from the pneumoperitoneum during MIS and the approximate surgical field during open surgery in 15 ml of sterilized phosphate-buffered saline. An RT-PCR test was performed on all collected samples to detect SARS-CoV-2 viral particles. Twelve patients with proven SARS-CoV-2 infection underwent open abdominal surgery. Two SARS-CoV-2-positive patients underwent an MIS procedure. The control group included 24 patients: 12 underwent open surgery and 12 MIS. One intraabdominal swab in a patient with SARS-CoV-2 infection was positive for SARS-CoV-2. However, during both open surgery and MIS, none of the surgical smoke samples showed any detectable viral particles of SARS-CoV-2. The air samples collected at the end of the surgical procedure showed no viral particles of SARS-CoV-2. Major complications (CD ≥ IIIa) were more often observed in SARS-CoV-2 positive patients (10 vs. 4, p = 0.001). This study showed no detectable viral particles of SARS-CoV-2 in surgical smoke sampled during MIS and open surgery. Thus, the discussed risk of transmission of SARS-CoV-2 via surgical smoke could not be confirmed in the present study.
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Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa M Eichel
- Department of Infectious Diseases, Section Infection Control University Hospital Heidelberg, Heidelberg, Germany
| | - Niklas M Weidner
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp A Wise
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Müller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingmar F Rompen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
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10
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Thomson WR, Puthucheary ZA, Wan YI. Critical care and pandemic preparedness and response. Br J Anaesth 2023; 131:847-860. [PMID: 37689541 PMCID: PMC10636520 DOI: 10.1016/j.bja.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 07/23/2023] [Indexed: 09/11/2023] Open
Abstract
Critical care was established partially in response to a polio epidemic in the 1950s. In the intervening 70 yr, several epidemics and pandemics have placed critical care and allied services under extreme pressure. Pandemics cause wholesale changes to accepted standards of practice, require reallocation and retargeting of resources and goals of care. In addition to clinical acumen, mounting an effective critical care response to a pandemic requires local, national, and international coordination in a diverse array of fields from research collaboration and governance to organisation of critical care networks and applied biomedical ethics in the eventuality of triage situations. This review provides an introduction to an array of topics that pertain to different states of pandemic acuity: interpandemic preparedness, alert, surge activity, recovery and relapse through the literature and experience of recent pandemics including COVID-19, H1N1, Ebola, and SARS.
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Affiliation(s)
- William R Thomson
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
| | - Zudin A Puthucheary
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Yize I Wan
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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11
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Eain MMG, Nolan K, Murphy B, McCaul C, MacLoughlin R. Exhaled patient derived aerosol dispersion during awake tracheal intubation with concurrent high flow nasal therapy. J Clin Monit Comput 2023; 37:1265-1273. [PMID: 36930390 PMCID: PMC10022553 DOI: 10.1007/s10877-023-00990-x] [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: 10/10/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
Awake Tracheal Intubation (ATI) can be performed in cases where there is potential for difficult airway management. It is considered an aerosol generating procedure and is a source of concern to healthcare workers due to the risk of transmission of airborne viral infections, such as SARS-CoV-2. At present, there is a lack of data on the quantities, size distributions and spread of aerosol particles generated during such procedures. This was a volunteer observational study which took place in an operating room of a university teaching hospital. Optical particle sizers were used to provide real time aerosol characterisation during a simulated ATI performed with concurrent high-flow nasal oxygen therapy. The particle sizers were positioned at locations that represented the different locations of clinical staff in an operating room during an ATI. The greatest concentration of patient derived aerosol particles was within 0.5-1.0 m of the subject and along their midline, 2242 #/cm3. As the distance, both radial and longitudinal, from the subject increased, the concentration decreased towards ambient levels, 36.9 ± 5.1 #/cm3. Patient derived aerosol particles < 5 µm in diameter remained entrained in the exhaled aerosol plume and fell to the floor or onto the subject. Patient derived particles > 5 µm in diameter broke away from the exhaled plume and spread radially throughout the operating room. Irrespective of distance and ventilation status, full airborne protective equipment should be worn by all staff when ATI is being performed on patients with suspected viral respiratory infections.
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Affiliation(s)
- Marc Mac Giolla Eain
- Research and Development, Science and Emerging Technologies, Aerogen Ltd, IDA Business Park, Dangan, Galway, H91HE94, Ireland
| | - Kevin Nolan
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Brian Murphy
- Department of Anaesthesia, Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - Conan McCaul
- Department of Anaesthesia, Rotunda Hospital, Parnell Square, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen Ltd, IDA Business Park, Dangan, Galway, H91HE94, Ireland.
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland.
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
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12
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Lin SY, Sun JS, Hung MC, Chang JZC. Effectiveness of mouth rinses against COVID-19: a systematic review and network meta-analysis. J Hosp Infect 2023; 139:175-191. [PMID: 37419189 DOI: 10.1016/j.jhin.2023.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE This systematic review and network meta-analysis (NMA) comprehensively compared the effectiveness of different mouth rinses in reducing the viral load/infectivity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (Part I), alleviating clinical symptoms or severity of disease (Part II), and decreasing the incidence of SARS-CoV-2 infection (Part III). METHODS Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) with restrictions were searched up to 3rd March 2023. Twenty-three studies (22 RCTs and one NRCT) met the inclusion criteria for this systematic review. RESULTS Five RCTs (454 patients and nine interventions) in Part I were eligible for NMA. The NMA results showed that, in comparison with no rinse, sodium chloride (NaCl) was the most effective mouth rinse for reducing the viral load, followed by povidone-iodine (PVP-I), ß-cyclodextrin + citrox (CDCM), hydrogen peroxide (HP), chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), placebo and hypochlorous acid (HClO). However, these results were not significant. Based on surface under the cumulative ranking curve scores, PVP-I was likely to be the most efficacious mouth rinse for reducing SARS-CoV-2 viral load, followed by CDCM, HP, NaCl, CHX, CPC, placebo, no rinse and HClO. CONCLUSION Due to heterogeneity of the primary studies, the effectiveness of different mouth rinses to reduce viral infectivity, improve clinical symptoms or prevent SARS-CoV-2 infection remains inconclusive.
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Affiliation(s)
- S-Y Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - J-S Sun
- Department of Orthopaedic Surgery, College of Medicine, China Medical University, Taichung, Taiwan; Department of Orthopaedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - M-C Hung
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - J Z-C Chang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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13
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Komiya K, Yoshida M, Uchida S, Takikawa S, Yamasue M, Matsumoto T, Morishige Y, Aono A, Hiramatsu K, Yamaoka Y, Nishizono A, Ato M, Kadota JI, Mitarai S. Massive and Lengthy Clonal Nosocomial Expansion of Mycobacterium abscessus subsp. massiliense among Patients Who Are Ventilator Dependent without Cystic Fibrosis. Microbiol Spectr 2023; 11:e0490822. [PMID: 37314340 PMCID: PMC10433864 DOI: 10.1128/spectrum.04908-22] [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: 11/29/2022] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
Nontuberculous mycobacterial infections are generally believed to be independently acquired from the environment. Although person-to-person transmission of nontuberculous mycobacteria, especially Mycobacterium abscessus subsp. massiliense, is a serious concern among individuals with cystic fibrosis (CF), evidence of its spread among patients without CF has never been established. We unexpectedly found a number of M. abscessus subsp. massiliense cases among patients without CF in a hospital. This study aimed to define the mechanism of M. abscessus subsp. massiliense infection among patients who were ventilator dependent and without CF who had progressive neurodegenerative diseases in our long-term care wards from 2014 to 2018 during suspected nosocomial outbreaks. We conducted whole-genome sequencing of M. abscessus subsp. massiliense isolates from 52 patients and environmental samples. Potential opportunities for in-hospital transmission were analyzed using epidemiological data. M. abscessus subsp. massiliense was isolated from one air sample obtained near a patient without CF who was colonized with M. abscessus subsp. massiliense but not from other potential sources. Phylogenetic analysis of the strains from these patients and the environmental isolate revealed clonal expansion of near-identical M. abscessus subsp. massiliense isolates, with the isolates generally differing by fewer than 22 single nucleotide polymorphisms (SNPs). Approximately half of the isolates differed by fewer than nine SNPs, indicating interpatient transmission. Whole-genome sequencing revealed a potential nosocomial outbreak among patients who were ventilator dependent and without CF. IMPORTANCE The isolation of M. abscessus subsp. massiliense from the air, but not from environmental fluid samples, may suggest airborne transmission. This was the first report to demonstrate person-to-person transmission of M. abscessus subsp. massiliense, even among patients without CF. M. abscessus subsp. massiliense may spread among patients who are ventilator dependent without CF through direct or indirect in-hospital transmission. The current infection control measures should address potential transmission among patients without CF, particularly in facilities that treat patients who are ventilator dependent and patients with preexisting chronic pulmonary diseases, such as CF.
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Affiliation(s)
- Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Mitsunori Yoshida
- Department of Mycobacteriology, Leprosy Research Centre, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Sonoe Uchida
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Beppu, Oita, Japan
- Respiratory Medicine, Bungoono City Hospital, Bungoono, Oita, Japan
| | - Shuichi Takikawa
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Beppu, Oita, Japan
| | - Mari Yamasue
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, Beppu, Oita, Japan
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yuta Morishige
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Akio Aono
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yoshio Yamaoka
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Akira Nishizono
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Manabu Ato
- Department of Mycobacteriology, Leprosy Research Centre, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Jun-ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
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Hung TY, Wen CS, Yu SH, Chen YC, Chen HL, Chen WL, Wu CC, Su YC, Lin CL, Hu SC, Lin T. A comparative analysis of aerosol exposure and prevention strategies in bystander, pre-hospital, and inpatient cardiopulmonary resuscitation using simulation manikins. Sci Rep 2023; 13:12552. [PMID: 37532861 PMCID: PMC10397338 DOI: 10.1038/s41598-023-39726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023] Open
Abstract
To evaluate aerosol exposure risk and prevention strategies during bystander, pre-hospital, and inpatient cardiopulmonary resuscitation (CPR). This study compared hands-only CPR, CPR with a surgical or N95 mask, and CPR with a non-rebreather mask at 15 L/min. 30:2 compression-ventilation ratio CPR was tested with face-mask ventilation (FMV), FMV with a high efficiency particulate air (HEPA) filter; supraglottic airway (SGA), SGA with a surgical mask, SGA with a HEPA filter, or SGA with both. Continuous CPR was tested with an endotracheal tube (ET), ET with a surgical mask, a HEPA filter, or both. Aerosol concentration at the head, trunk, and feet of the mannequin were measured to evaluate exposure to CPR personnel. Hands-only CPR with a surgical or N95 face mask coverings and ET tube ventilation CPR with filters showed the lowest aerosol exposure among all study groups, including CPR with NRM oxygenation, FMV, and SGA ventilation. NRM had a mask effect and reduced aerosol exposure at the head, trunk, and feet of the mannequin. FMV with filters during 30:2 CPR reduced aerosol exposure at the head and trunk, but increased at the feet of the mannequin. A tightly-sealed SGA when used with a HEPA filter, reduced aerosol exposure by 21.00-63.14% compared with a loose-fitting one. Hands-only CPR with a proper fit surgical or N95 face mask coverings is as safe as ET tube ventilation CPR with filters, compared with CPR with NRM, FMV, and SGA. FMV or tight-sealed SGA ventilation with filters prolonged the duration to achieve estimated infective dose of SARS-CoV-2 2.4-2.5 times longer than hands-on CPR only. However, a loose-fitting SGA is not protective at all to chest compressor or health workers standing at the foot side of the victim, so should be used with caution even when using with HEPA filters.
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Affiliation(s)
- Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan
| | - Chung-Shiung Wen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Sheng-Han Yu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Yi-Chang Chen
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Wei-Lun Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chih-Chieh Wu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Taiwan.
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, No.539, Zhongxiao Rd., East Dist., Chiayi City, 600566, Taiwan.
| | - Chun-Lung Lin
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Shih-Cheng Hu
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tee Lin
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
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15
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Evrin T, Dabkowski M, Pruc M, Hernik J, Wieczorek W, Chabowski L, Wieczorek P, Chmielewski J, Feduniw S, Szarpak L. ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study. J Clin Med 2023; 12:5074. [PMID: 37568476 PMCID: PMC10419956 DOI: 10.3390/jcm12155074] [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: 07/04/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.
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Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, Medical Faculty, Ufuk University, 06510 Ankara, Turkey
| | - Miroslaw Dabkowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, International Academy of Ecology and Medicine, 02000 Kyiv, Ukraine
| | - Jacek Hernik
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
| | - Wojciech Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Warsaw, 02-013 Warsaw, Poland
| | - Lukasz Chabowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, Odessa International Medical University, 12042 Odessa, Ukraine
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Pediatric Intensive Care Unit (PICU), John Paul II Upper Silesian Health Centre in Katowice, 40-752 Katowice, Poland
| | - Jaroslaw Chmielewski
- Institute of Environmental Protection—National Research Institute (IEP-NRI), 02-170 Warsaw, Poland
- Department of Public Health, International European University, 03187 Kyiv, Ukraine
| | - Stepan Feduniw
- Department of Obstetrics, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
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16
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Howard NS, Alrefaie A, Mejia NA, Ugbeye T, Schmidt BE. Characterizing Aerosol Generating Procedures With Background Oriented Schlieren. J Biomech Eng 2023; 145:074502. [PMID: 36961437 PMCID: PMC10158973 DOI: 10.1115/1.4062191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
The potential for characterizing aerosol generating procedures (AGPs) using background oriented schlieren (BOS) flow visualization was investigated in two clinical situations. A human-scale BOS system was used on a manikin simulating jet ventilation and extubation. A novel approach to representation of the BOS images using line integral convolution allows direct evaluation of both magnitude and direction of the refractive index gradient field. Plumes issuing from the manikin's mouth were clearly visualized and characterized in both experiments, and it is recommended that BOS be adapted into a clinical tool for risk evaluation in clinical environments.
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Affiliation(s)
- N. Scott Howard
- School of Medicine, Case Western Reserve University Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106
| | - Abdulaziz Alrefaie
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University Cleveland, Cleveland, OH 44106
| | - Nicholas A. Mejia
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University Cleveland, Cleveland, OH 44106
| | - Tosan Ugbeye
- S.C.O.P.E. Medical Cleveland, Cleveland, OH 44106
| | - Bryan E. Schmidt
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University Cleveland, Cleveland, OH 44106
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17
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Jang W, Kang H, Shin H, Kim C, Lee H, Choi H. Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study. J Pers Med 2023; 13:1017. [PMID: 37374006 DOI: 10.3390/jpm13061017] [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: 05/10/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Aerosols and droplets have put healthcare workers performing airway management at high risk of contracting coronavirus disease 2019 (COVID-19). Experts have developed endotracheal intubation (ETI) guidelines and protocols to protect intubators from infection. We aimed to determine whether changes in the emergency department (ED) intubation protocol to prevent COVID-19 infection were associated with first-pass success (FPS) rates in ETI. We used data from the airway management registries in two academic EDs. The study was divided into pre-pandemic (January 2018 to January 2020) and pandemic (February 2020 to February 2022) periods. We selected 2476 intubation cases, including 1151 and 1325 cases recorded before and during the pandemic, respectively. During the pandemic, the FPS rate was 92.2%, which did not change significantly, and major complications increased slightly but not significantly compared with the pre-pandemic period. The OR for the FPS of applying infection prevention intubation protocols was 0.72 (p = 0.069) in a subgroup analysis, junior emergency physicians (PGY1 residents) had an FPS of less than 80% regardless of pandemic protocol implementation. The FPS rate of senior emergency physicians in physiologically difficult airways decreased significantly during the pandemic (98.0% to 88.5%). In conclusion, the FPS rate and complications for adult ETI performed by emergency physicians using COVID-19 infection prevention intubation protocols were similar to pre-pandemic conditions.
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Affiliation(s)
- Wooseok Jang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Hyukjoong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
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18
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Woo CC. COVID-19-specific adult basic life support guideline strategies for chiropractors and other healthcare providers to maximize the safety and efficacy of resuscitation: a commentary. Chiropr Man Therap 2023; 31:16. [PMID: 37277875 DOI: 10.1186/s12998-023-00488-y] [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: 01/23/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The emergence of an unprecedented novel severe acute respiratory syndrome coronavirus-2 (SARS-C0V-2), which causes the coronavirus disease 2019 (COVID-19) pandemic, has created new scenarios in basic life support (BLS) management. According to current evidence, SARS-CoV-2 can be transmitted airborne in aerosol particles during resuscitation. Research evidence found an alarming global increase in out-of-hospital cardiac arrests during the COVID-19 pandemic. Healthcare providers are legally obliged to respond to cardiac arrest as soon as possible. Chiropractors will likely encounter potential exercise-related and non-exercise-related cardiac emergencies at some point in their professional lives. They have a duty of care to respond to emergencies such as cardiac arrest. Chiropractors are increasingly involved in providing care, including emergency care, for athletes and spectators at sporting events. Also, exercise-related cardiac arrest in adult patients may occur during exercise testing or rehabilitation with exercise prescriptions in chiropractic and other healthcare settings. Little is known about the COVID-19 BLS guidelines for chiropractors. Knowledge of the current COVID-19-specific adult BLS guidelines is essential to developing an emergency response plan for the on-field and sideline management of exercise-related cardiac arrest and non-athletic, non-exercise-related cardiac arrest. MAIN TEXT Seven peer-reviewed articles on the COVID-19-specific BLS guidelines, including two updates, were reviewed for this commentary. Responding to the COVID-19 pandemic, the national and international resuscitation organizations recommended interim COVID-19-specific BLS guidelines with precaution, resuscitation, and education strategies. BLS safety is paramount. A precautionary approach with the bare minimum of appropriate personal protective equipment for resuscitation is recommended. There was disagreement among the COVID-19 BLS guidelines on the level of personal protective equipment. All healthcare professionals should also undergo self-directed BLS e-learning and virtual skill e-training. The summarized COVID-19-specific adult BLS guideline strategies and protocols are tabled, respectively. CONCLUSIONS This commentary provides a practical overview and highlights current evidence-based intervention strategies of the COVID-19-specific adult BLS guidelines that may help chiropractors and other healthcare providers reduce BLS-related exposures to SARS-CoV-2 and the risks of SARS-CoV-2 transmission and maximize the efficacy of resuscitation. This study is relevant to and impacts future COVID-19-related research in areas such as infection prevention and control.
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Affiliation(s)
- Chun-Cheung Woo
- CC Woo Chiropractic Clinic, Chatswood, NSW, 2057, Australia.
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19
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Webb WM, Covey AE. Risk of Occupational HPV Exposure Among Medical Trainees: A Call for HPV Vaccination. Kans J Med 2023; 16:143. [PMID: 37283778 PMCID: PMC10241205 DOI: 10.17161/kjm.vol16.19567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/11/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- William M Webb
- Departments of Internal Medicine and Psychiatry, University of Kansas Medical Center, Kansas City, KS
| | - Andrea E Covey
- Kansas City Veterans Affairs Medical Center, Kansas City, MO
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20
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Garner O, Velamuri K, Staggers K, Braun AB. Impact of the COVID-19 pandemic on the education and procedural volume of fellows in critical care medicine - a cross-sectional survey. BMC MEDICAL EDUCATION 2023; 23:371. [PMID: 37226108 DOI: 10.1186/s12909-023-04358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the way medical education is delivered. The purpose of this study was to assess the impact of the COVID-19 pandemic on the education and procedural volume of critical care and pulmonary critical care fellows. METHODS We conducted a cross-sectional, internet-based, voluntary, anonymous, national survey of adult critical care fellows and academic attending physicians in critical care and pulmonary critical care fellowship programs in the United States between December 2020 and February 2021. Survey questions covered both didactic and non-didactic aspects of education and procedural volumes. Answers were ranked on a 5-point Likert scale. Survey responses were summarized by frequency with percentage. Differences between the responses of fellows and attendings were assessed with the Fisher's exact or Chi-Square test, using Stata 16 software (StataCorp LLC, College Station, TX). RESULTS Seventy four individuals responded to the survey; the majority (70.3%) were male; less than one-third (28.4%) female. Respondents were evenly split among fellows (52.7%) and attendings (47.3%). 41.9% of survey respondents were from the authors' home institution, with a response rate of 32.6%. Almost two-thirds (62.2%) reported that fellows spend more time in the ICU since the onset of the pandemic. The majority noted that fellows insert more central venous catheters (52.7%) and arterial lines (58.1%), but perform fewer bronchoscopies (59.5%). The impact on endotracheal intubations was mixed: almost half of respondents (45.9%) reported fewer intubations, about one-third (35.1%) more intubations. Almost all respondents (93.0%) described fewer workshops; and one-third (36.1%) fewer didactic lectures. The majority (71.2%) noted less time available for research and quality improvement projects; half (50.7%) noted less bedside teaching by faculty and more than one-third (37.0%) less fellow interaction with faculty. Almost one-half of respondents (45.2%) reported an increase in fellows' weekly work hours. CONCLUSION The pandemic has caused a decrease in scholarly and didactic activities of critical care and pulmonary critical care fellows. Fellows spend more time in ICU rotations, insert more central and arterial lines, but perform fewer intubations and bronchoscopies. This survey provides insights into changes that have occurred in the training of critical care and pulmonary critical care fellows since the onset of the COVID-19 pandemic.
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Affiliation(s)
- Orlando Garner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kanta Velamuri
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kristen Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Andrea Barbara Braun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
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21
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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.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
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22
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Jniene A, Rhanim A, Herrak L, Achachi L, Ftouh ME. How COVID-19 changed our bronchoscopy procedures: A comparison with the Portuguese Pulmonology Society Recommendations. Pulmonology 2023; 29:157-159. [PMID: 36180347 PMCID: PMC9376307 DOI: 10.1016/j.pulmoe.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Jniene
- Department of Pulmonology, Ibn Sina Hospital, Ibn Sina University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: abderrahim bouabid avenue, 10100, Rabat, Morocco; Exercise Physiology and Autonomic Nervous System Team "EPE-SNA", Laboratory of Physiology, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: impasse souissi, 10100, Rabat, Morocco.
| | - A Rhanim
- Department of Pulmonology, Ibn Sina Hospital, Ibn Sina University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: abderrahim bouabid avenue, 10100, Rabat, Morocco
| | - L Herrak
- Department of Pulmonology, Ibn Sina Hospital, Ibn Sina University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: abderrahim bouabid avenue, 10100, Rabat, Morocco
| | - L Achachi
- Department of Pulmonology, Ibn Sina Hospital, Ibn Sina University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: abderrahim bouabid avenue, 10100, Rabat, Morocco
| | - M El Ftouh
- Department of Pulmonology, Ibn Sina Hospital, Ibn Sina University Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Postal address: abderrahim bouabid avenue, 10100, Rabat, Morocco
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23
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Boccia G, Di Spirito F, D’Ambrosio F, De Caro F, Pecora D, Giorgio R, Fortino L, Longanella W, Franci G, Santella B, Amato M. Microbial Air Contamination in a Dental Setting Environment and Ultrasonic Scaling in Periodontally Healthy Subjects: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032710. [PMID: 36768076 PMCID: PMC9916071 DOI: 10.3390/ijerph20032710] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 05/14/2023]
Abstract
The risk of microbial air contamination in a dental setting, especially during aerosol-generating dental procedures (AGDPs), has long been recognized, becoming even more relevant during the COVID-19 pandemic. However, individual pathogens were rarely studied, and microbial loads were measured heterogeneously, often using low-sensitivity methods. Therefore, the present study aimed to assess microbial air contamination in the dental environment, identify the microorganisms involved, and determine their count by active air sampling at the beginning (T0), during (T1), and at the end (T2) of ultrasonic scaling in systemically and periodontally healthy subjects. Air microbial contamination was detected at T0 in all samples, regardless of whether the sample was collected from patients treated first or later; predominantly Gram-positive bacteria, including Staphylococcus and Bacillus spp. and a minority of fungi, were identified. The number of bacterial colonies at T1 was higher, although the species found were similar to that found during the T0 sampling, whereby Gram-positive bacteria, mainly Streptococcus spp., were identified. Air samples collected at T2 showed a decrease in bacterial load compared to the previous sampling. Further research should investigate the levels and patterns of the microbial contamination of air, people, and the environment in dental settings via ultrasonic scaling and other AGDPs and identify the microorganisms involved to perform the procedure- and patient-related risk assessment and provide appropriate recommendations for aerosol infection control.
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Affiliation(s)
- Giovanni Boccia
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Igiene Ospedaliera, A.O.U. San Giovanni di Dio e Ruggi D’Aragona Largo Città di Ippocrate, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesco De Caro
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Igiene Ospedaliera, A.O.U. San Giovanni di Dio e Ruggi D’Aragona Largo Città di Ippocrate, 84131 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Domenico Pecora
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Riccardo Giorgio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Luigi Fortino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | | | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Biagio Santella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
- Correspondence: (B.S.); (M.A.)
| | - Massimo Amato
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
- Correspondence: (B.S.); (M.A.)
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24
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Kondo R, Austin J, Akel M, Arora VM, Press VG. Estimated cost-savings from optimizing use of inhaled medications for inpatients with obstructive lung disease. J Asthma 2023; 60:323-330. [PMID: 35230210 PMCID: PMC9549903 DOI: 10.1080/02770903.2022.2047718] [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: 08/06/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
CONCLUSIONS Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education.
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Affiliation(s)
- Ryuhei Kondo
- Integral Corporation and The University of Chicago Booth School of Business, Chicago, IL, USA
| | - Jennifer Austin
- Department of Pharmacy, The Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mary Akel
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Valerie G Press
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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25
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Ramírez-Torres CA, Rivera-Sanz F, Sufrate-Sorzano T, Pedraz-Marcos A, Santolalla-Arnedo I. Closed Endotracheal Suction Systems for COVID-19: Rapid Review. Interact J Med Res 2023; 12:e42549. [PMID: 36548950 PMCID: PMC9874988 DOI: 10.2196/42549] [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: 09/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. OBJECTIVE This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. METHODS A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." RESULTS A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. CONCLUSIONS Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.
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Affiliation(s)
- Carmen Amaia Ramírez-Torres
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Teresa Sufrate-Sorzano
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Ivan Santolalla-Arnedo
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
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26
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Dell'Olio A, Vocale C, Primavera A, Pisani L, Altavilla S, Roncarati G, Tumietto F, Viale P, Re MC, Lazzarotto T, Nava S, Ranieri VM, Tonetti T. Environmental Contamination by SARS-CoV-2 During Noninvasive Ventilation in COVID-19. Respir Care 2023; 68:1-7. [PMID: 36379641 PMCID: PMC9993510 DOI: 10.4187/respcare.10323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental contamination by SARS-CoV-2 from patients with COVID-19 undergoing noninvasive ventilation (NIV) in the ICU is still under investigation. This study set out to investigate the presence of SARS-CoV-2 on surfaces near subjects receiving NIV in the ICU under controlled conditions (ie, use of dual-limb circuits, filters, adequate room ventilation). METHODS This was a single-center, prospective, observational study in the ICU of a tertiary teaching hospital. Four surface sampling areas, at increasing distance from subject's face, were identified; and each one was sampled at fixed intervals: 6, 12, and 24 h. The presence of SARS-CoV-2 was detected with real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) test on environmental swabs; the RT-PCR assay targeted the SARS-CoV-2 virus nucleocapsid N1 and N2 genes and the human RNase P gene as internal control. RESULTS In a total of 256 collected samples, none were positive for SARS-CoV-2 genetic material, whereas 21 samples (8.2%) tested positive for RNase P, thus demonstrating the presence of genetic material unrelated to SARS-CoV-2. CONCLUSIONS Our data show that application of NIV in an appropriate environment and with correct precautions leads to no sign of surface environmental contamination. Accordingly, our data support the idea that use of NIV in the ICU is safe both for health care workers and for other patients.
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Affiliation(s)
- Alessio Dell'Olio
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Caterina Vocale
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Primavera
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lara Pisani
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Altavilla
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Roncarati
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Tumietto
- Antimicrobial Stewardship Unit, Metropolitan Department Integrated Management Infectious Risk, AUSL Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Carla Re
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Nava
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Tawel R, Altawil L, Hassan Koya S, Jaouni H, Alinier G, Nashwan AJ, Labib A. Risk of COVID-19 infection among mobile extracorporeal membrane oxygenation team. Health Sci Rep 2023; 6:e981. [PMID: 36514330 PMCID: PMC9731299 DOI: 10.1002/hsr2.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aim The transport of coronavirus-2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) is a challenging situation, especially for healthcare workers (HCWs), due to the risk of cross-infection. Hence, certain precautions are needed for their safety. The study aims to evaluate the risk of COVID-19 transmission to HCWs who transport COVID-19 patients on ECMO device. Methods A retrospective review of adult patients with COVID-19 infection supported with ECMO and transported by ground route to the Medical Intensive Care Unit (MICU) at Hamad General Hospital (HGH) and a survey of HCWs involved in those cases. Results A total of 63 HCWs of the mobile ECMO team were exposed to COVID-19-positive patients on 199 occasions. HCWs exposure time was nearly 110 h, and the total transport distance was 1018 km. During the study period, only two of the mobile ECMO HCWs tested positive for COVID-19. There was zero incidence of transfer-associated injuries or accidents to HCWs. Conclusions The risk of COVID-19 cross-infection to the mobile ECMO team seems to be very low, provided that strict infection prevention and control measures are applied.
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Affiliation(s)
- Rabee Tawel
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | - Lubna Altawil
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | | | - Hani Jaouni
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | - Guillaume Alinier
- Ambulance ServiceHamad Medical CorporationDohaQatar
- Weill Cornell Medicine‐QatarDohaQatar
- University of HertfordshireHatfieldUK
- Northumbria UniversityNewcastle upon TyneUK
| | | | - Ahmed Labib
- Medical Intensive Care UnitHamad General HospitalDohaQatar
- Ambulance ServiceHamad Medical CorporationDohaQatar
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Chan SM, Ma TW, Chu S, Fei HS, Futaba K, Yip HC, Teoh AYB, Wong MCS, Ng SSM, Ng EKW, Chiu PWY. Droplet nuclei are generated during colonoscopy and are decreased by the use of carbon dioxide and water immersion technique. Dig Endosc 2023; 35:77-85. [PMID: 35751478 DOI: 10.1111/den.14387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether CS are aerosol-generating procedures. METHODS This was a prospective observational trial including all patients undergoing CS at the Prince of Wales Hospital from 1 June to 31 July 2020. Three particle counters were placed 10 cm from each patient's anus and near the mouth of endoscopists and nurses. The particle counter recorded the number of particles of size 0.3, 0.5, 0.7, 1, 5, and 10 μm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique, and air particle count (particles/cubic foot, dCF) were recorded. Multilevel modeling was used to test all the hypotheses with a post-hoc analysis. RESULTS A total of 117 patients were recruited. During CS, the level of 5 μm and 10 μm were significantly higher than the baseline period (P = 0.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3 μm, P < 0.001; 0.5 μm and 0.7 μm, P < 0.001). The use of CO2 and water immersion techniques had significantly lower aerosols generated when compared to air (CO2 : 0.3, 0.5, and 0.7 μm: P < 0.001; water immersion: 0.3 μm: P = 0.048; 0.7 μm: P = 0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus and endoscopists' and nurses' level during rectal extubation. CONCLUSION Colonoscopy generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.
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Affiliation(s)
- Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tsz Wah Ma
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Chu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hon Sok Fei
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kaori Futaba
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hon Chi Yip
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Martin Chi-Sang Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Siu Man Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Pepe DE, Mehrotra P, Bruno-Murtha LA, Colgrove R, Doron S, Duncan R, Ellison R, Haessler S, Hooper DC, Klompas M, Pierre CM, Sandora TJ, Shenoy ES, Wright SB. Use of expert consensus to develop a shared list of procedures with potential for aerosol generation during the coronavirus disease 2019 (COVID-19) pandemic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e44. [PMID: 36960085 PMCID: PMC10028938 DOI: 10.1017/ash.2023.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 03/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.
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Affiliation(s)
- Dana E. Pepe
- Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Author for correspondence: Dana E. Pepe, MD, MPH, Beth Israel Deaconess Medical Center, 330 Brookline Ave, SL-435, Boston, MA02215. E-mail:
| | - Preeti Mehrotra
- Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Lou Ann Bruno-Murtha
- Division of Infectious Diseases, Cambridge Health Alliance, Cambridge, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Robert Colgrove
- Infectious Diseases Division, Mount Auburn Hospital, Cambridge, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Shira Doron
- The Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Hospital, Boston, Massachusetts
| | - Robert Duncan
- Division of Infectious Diseases, Lahey Hospital & Medical Center, Burlington, Massachusetts
- Tufts University School of Medicine, Hospital, Boston, Massachusetts
| | - Richard Ellison
- Division of Infectious Diseases & Immunology, UMass Memorial Medical Center, Worcester, Massachusetts
- Division of Infectious Diseases & Immunology, UMass Chan Medical School, Worcester, Massachusetts
| | - Sarah Haessler
- Division of Infectious Diseases, Baystate Medical Center, Springfield, Massachusetts
- UMass Chan Medical School-Baystate, Worcester, Massachusetts
| | - David C. Hooper
- Division of Infectious Diseases; Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michael Klompas
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Cassandra M. Pierre
- Section of Infectious Diseases, Boston University Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Thomas J. Sandora
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erica S. Shenoy
- Division of Infectious Diseases; Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sharon B. Wright
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Beth Israel Lahey Health, Cambridge, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Chaussade S, Pellat A, Corre F, Hallit R, Abou Ali E, Belle A, Barret M, Chaussade P, Coriat R. A new system to prevent SARS-CoV-2 and microorganism air transmission through the air circulation system of endoscopes. Endosc Int Open 2022; 10:E1589-E1594. [PMID: 36531679 PMCID: PMC9754862 DOI: 10.1055/a-1907-3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Evidence for the modes of transmission of SARS-CoV-2 remains controversial. Recently, the potential for airborne spread of SARS-CoV-2 has been stressed. Air circulation in gastrointestinal light source boxes and endoscopes could be implicated in airborne transmission of microorganisms. Methods The ENDOBOX SC is a 600 × 600 mm cube designed to contain any type of machine used during gastrointestinal endoscopy. It allows for a 100-mm space between a machine and the walls of the ENDOBOX SC. To use the ENDOBOX SC, it is connected to the medical air system and it provides positive flow from the box to the endoscopy room. The ENDOBOX SC uses medical air to inflate the digestive tract and to decrease the temperature induced by the microprocessors or by the lamp. ENDOBOX SC has been investigated in different environments. Results An endoscopic procedure performed without ventilation was interrupted after 40 minutes to prevent computer damage. During the first 30 minutes, the temperature increased from 18 °C to 31 °C with a LED system. The procedure with fans identified variations in temperature inside the ENDOBOX SC from 21 to 26 °C (± 5 °C) 1 hour after the start of the procedure. The temperature was stable for the next 3 hours. Conclusions ENDOBOX SC prevents the increase in temperature induced by lamps and processors, allows access to all necessary connections into the endoscopic columns, and creates a sterile and positive pressure volume, which prevents potential contamination from microorganisms.
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Affiliation(s)
- Stanislas Chaussade
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Anna Pellat
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Felix Corre
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Rachel Hallit
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Paul Chaussade
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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Chabot K, Yang SS. Pharmacologic methods to minimise coughing during extubation in the era of COVID-19. J Perioper Pract 2022:17504589221132404. [PMID: 36482722 PMCID: PMC9742728 DOI: 10.1177/17504589221132404] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND/AIM Given the current severe acute respiratory syndrome coronavirus 2 pandemic, coughing at the time of extubation is at risk of creating aerosolisation. This may place health care workers at risk of nosocomial infection during the perioperative period. This study aims to summarise the current pharmacologic methods to minimise cough at the time of extubation, and to determine whether some strategies could be more beneficial than others. METHODS This is a summary of systematic reviews. A comprehensive search through MEDLINE was performed. Thirty-three publications were screened for eligibility. Only the manuscripts discussing pharmacologic methods to minimise coughing on extubation were included in this review. FINDINGS Many pharmacological agents have been proposed to decrease the incidence of cough at the time of extubation. Of these, intravenous administration of dexmedetomidine (relative risk 0.4; 95% CI: 0.4-0.5) or remifentanil (RR 0.4; 95% CI: 0.4-0.5) seems to have the largest effect to reduce cough on extubation. CONCLUSION The available data in the current literature is sparse. Yet, dexmedetomidine and remifentanil seem to be the most efficient agents to decrease the incidence of emergence coughing.
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Affiliation(s)
- Katherine Chabot
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Stephen Su Yang
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
- Division of Critical Care, McGill University, Montreal, QC, Canada
- Lady Davis Institute of Research, Jewish General Hospital, Montreal, QC, Canada
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32
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Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice. J Pers Med 2022; 12:jpm12122000. [PMID: 36556221 PMCID: PMC9788482 DOI: 10.3390/jpm12122000] [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: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022] Open
Abstract
The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.
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Mac Giolla Eain M, Cahill R, MacLoughlin R, Nolan K. Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control. Drug Deliv 2022; 29:10-17. [PMID: 34962221 PMCID: PMC8725970 DOI: 10.1080/10717544.2021.2015482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/24/2022] Open
Abstract
Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3-83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, p≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.
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Affiliation(s)
| | - Ronan Cahill
- School of Medicine, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Ronan MacLoughlin
- Aerogen Ltd, IDA Business Park, Galway, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Kevin Nolan
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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Joseph J, Baby HM, Zhao S, Li X, Cheung K, Swain K, Agus E, Ranganathan S, Gao J, Luo JN, Joshi N. Role of bioaerosol in virus transmission and material-based countermeasures. EXPLORATION (BEIJING, CHINA) 2022; 2:20210038. [PMID: 37324804 PMCID: PMC10190935 DOI: 10.1002/exp.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/15/2022] [Indexed: 06/17/2023]
Abstract
Respiratory pathogens transmit primarily through particles such as droplets and aerosols. Although often overlooked, the resuspension of settled droplets is also a key facilitator of disease transmission. In this review, we discuss the three main mechanisms of aerosol generation: direct generation such as coughing and sneezing, indirect generation such as medical procedures, and resuspension of settled droplets and aerosols. The size of particles and environmental factors influence their airborne lifetime and ability to cause infection. Specifically, humidity and temperature are key factors controlling the evaporation of suspended droplets, consequently affecting the duration in which particles remain airborne. We also suggest material-based approaches for effective prevention of disease transmission. These approaches include electrostatically charged virucidal agents and surface coatings, which have been shown to be highly effective in deactivating and reducing resuspension of pathogen-laden aerosols.
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Affiliation(s)
- John Joseph
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Helna Mary Baby
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Spencer Zhao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Xiang‐Ling Li
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Krisco‐Cheuk Cheung
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Kabir Swain
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Eli Agus
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Sruthi Ranganathan
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Jingjing Gao
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - James N Luo
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Nitin Joshi
- Center for Nanomedicine, Department of AnesthesiologyPerioperative and Pain Medicine, Brigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Lee VHF, Adham M, Ben Kridis W, Bossi P, Chen MY, Chitapanarux I, Gregoire V, Hao SP, Ho C, Ho GF, Kannarunimit D, Kwong DLW, Lam KO, Lam WKJ, Le QT, Lee AWM, Lee NY, Leung TW, Licitra L, Lim DWT, Lin JC, Loh KS, Lou PJ, Machiels JP, Mai HQ, Mesía R, Ng WT, Ngan RKC, Tay JK, Tsang RKY, Tong CC, Wang HM, Wee JT. International recommendations for plasma Epstein-Barr virus DNA measurement in nasopharyngeal carcinoma in resource-constrained settings: lessons from the COVID-19 pandemic. Lancet Oncol 2022; 23:e544-e551. [PMID: 36455583 PMCID: PMC9704820 DOI: 10.1016/s1470-2045(22)00505-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
The effects of the COVID-19 pandemic continue to constrain health-care staff and resources worldwide, despite the availability of effective vaccines. Aerosol-generating procedures such as endoscopy, a common investigation tool for nasopharyngeal carcinoma, are recognised as a likely cause of SARS-CoV-2 spread in hospitals. Plasma Epstein-Barr virus (EBV) DNA is considered the most accurate biomarker for the routine management of nasopharyngeal carcinoma. A consensus statement on whether plasma EBV DNA can minimise the need for or replace aerosol-generating procedures, imaging methods, and face-to-face consultations in managing nasopharyngeal carcinoma is urgently needed amid the current pandemic and potentially for future highly contagious airborne diseases or natural disasters. We completed a modified Delphi consensus process of three rounds with 33 international experts in otorhinolaryngology or head and neck surgery, radiation oncology, medical oncology, and clinical oncology with vast experience in managing nasopharyngeal carcinoma, representing 51 international professional societies and national clinical trial groups. These consensus recommendations aim to enhance consistency in clinical practice, reduce ambiguity in delivering care, and offer advice for clinicians worldwide who work in endemic and non-endemic regions of nasopharyngeal carcinoma, in the context of COVID-19 and other airborne pandemics, and in future unexpected settings of severe resource constraints and insufficiency of personal protective equipment.
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Affiliation(s)
- Victor Ho-Fun Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China,Correspondence to:Dr Victor Ho-Fun Lee, Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Marlinda Adham
- Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia–Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Wala Ben Kridis
- Department of Medical Oncology, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health–Medical Oncology, University of Brescia, ASST–Spedali Civili, Brescia, Italy,Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat–sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Sheng Po Hao
- Department of Otolaryngology, Shin Kong Wu Ho–Su Memorial Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Cheryl Ho
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gwo Fuang Ho
- Clinical Oncology Unit, University Malaya Cancer Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Danita Kannarunimit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dora Lai-Wan Kwong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Ka-On Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Wai Kei Jacky Lam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China,Department of Chemical Pathology, State Key Laboratory of Translational Oncology, and Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Anne Wing-Mui Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - To-Wai Leung
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy,Department of Oncology and Hemato–Oncology, University of Milan, Milan, Italy
| | | | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Kwok Seng Loh
- Department of Otolaryngology–Head & Neck Surgery, National University of Singapore, Singapore
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan,Graduate Institute of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jean-Pascal Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat–sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology–Badalona, B–ARGO Group, IGTP, Badalona, Spain
| | - Wai-Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Roger Kai-Cheong Ngan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Clinical Oncology Center, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Joshua K Tay
- Department of Otolaryngology–Head & Neck Surgery, National University of Singapore, Singapore
| | - Raymond King-Yin Tsang
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China,Department of Otolaryngology–Head & Neck Surgery, National University of Singapore, Singapore
| | - Chi-Chung Tong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Joseph T Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
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Kim H, Chang JE, Kim DK, Won D, Lee JM, Kim TK, Min SW, Lim H, Ma S, Hwang JY. Evaluation of the conventional and modified aerosol boxes during tracheal intubation in normal and difficult airways: a randomized, crossover, manikin simulation study. J Clin Monit Comput 2022; 36:1697-1702. [PMID: 35059912 PMCID: PMC8773385 DOI: 10.1007/s10877-022-00814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate conventional and modified aerosol boxes in terms of intubation time, first-pass intubation success, and mouth-to-mouth distance between the laryngoscopist and patient during tracheal intubation in simulated patients with normal and difficult airways. Sixteen anesthesiologists performed tracheal intubations with direct laryngoscope or three different videolaryngoscopes (McGRATH MAC videolaryngoscope, C-MAC videolaryngoscope, and Pentax-AWS) without an aerosol box or with a conventional or a modified aerosol boxes in simulated manikins with normal and difficult airways. Intubation time, first-pass intubation success, and mouth-to-mouth distance during tracheal intubation were recorded. Compared to no aerosol box, the use of a conventional aerosol box significantly increased intubation time in both normal and difficult airways (Bonferroni-corrected P-value (Pcorrected) = 0.005 and Pcorrected = 0.003, respectively). Intubation time was significantly shorter with the modified aerosol box than with the conventional one for both normal and difficult airways (Pcorrected = 0.003 and Pcorrected = 0.011, respectively). However, no significant differences were found in intubation time between no aerosol box and the modified aerosol box for normal and difficult airways (Pcorrected = 0.336 and Pcorrected = 0.112, respectively). The use of conventional or modified aerosol boxes significantly extended the mouth-to-mouth distances compared to not using an aerosol box during tracheal intubation with each laryngoscope (all Pcorrected < 0.05), and the distances were not different between the conventional and modified boxes in normal and difficult airways. The use of modified aerosol box did not increase intubation time and could help maintain a distance from the simulated patients with normal and difficult airways.
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Affiliation(s)
- Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
| | - Dae Kon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggido, Republic of Korea
| | - Dongwook Won
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
- Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seong-Won Min
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
- Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Haeun Lim
- Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seoyoung Ma
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea.
- Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111774. [PMID: 36421223 PMCID: PMC9689205 DOI: 10.3390/children9111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p < 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p < 0.001). On the Cormack−Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.
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Zemouri C, Beltrán EO, Holliday R, Jakubovics NS, Allison JR. Monkeypox: what do dental professionals need to know? Br Dent J 2022; 233:569-574. [PMID: 36241815 PMCID: PMC9568425 DOI: 10.1038/s41415-022-5079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
Infection control is critical for the safe delivery of dental care. Infection control practices must be responsive to emerging and re-emerging infectious diseases and outbreaks, as was clearly seen during the peak of the COVID-19 pandemic. An emerging global outbreak of the monkeypox virus has again raised potential challenges for infection control in dentistry. Monkeypox is an infectious disease, characterised by a rash affecting the skin and soft tissues, including the oral cavity. Previously, cases were mostly seen following contact with infected animals in Central and West Africa, with limited human-to-human transmission within and outside of these areas. However, since May 2022, sustained human-to-human transmission has occurred globally. Monkeypox can be transmitted via close contact with an infected person, contaminated objects and surfaces, or by droplets and possibly aerosols, which is therefore of potential importance to dental settings. This article discusses the relevance of monkeypox to dental professionals, the typical presentation of the disease, its potential impact on infection prevention and control practices and the delivery of dental services. The current monkeypox outbreak highlights the need for a more sustained programme of research into dental infection control that can provide a solid evidence base to underpin preparedness planning for future outbreaks and pandemics.
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Affiliation(s)
- Charifa Zemouri
- Zemouri Public Health Research and Consultancy, Amsterdam, The Netherlands
| | - Edgar O Beltrán
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Richard Holliday
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicholas S Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James R Allison
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Lin CH, Lin HY, Wu SN, Tseng WP, Chen WT, Tien YT, Wu CY, Huang CH, Tsai MS. Using a telemedicine-assisted airway model to improve the communication and teamwork of tracheal intubation during the coronavirus disease 2019 pandemic. J Telemed Telecare 2022:1357633X221124175. [PMID: 36066025 DOI: 10.1177/1357633x221124175] [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: 11/16/2022]
Abstract
INTRODUCTION Isolated spaces impair communication and teamwork during tracheal intubation (TI) in suspected coronavirus disease 2019 patients. We thus aimed to evaluate the telemedicine-assisted airway model (TAM) to improve communication and teamwork during the pandemic. METHODS This two-stage prospective study included adult patients intubated in the emergency department of the National Taiwan University Hospital between 1 August 2020 and 31 July 2021. First, we randomised patients receiving TI in the standard setting into the conventional group (Con-G) and the isolation area into the isolation group (Iso-G). We evaluated the obstacles to communication and teamwork in an isolation scenario. Second, we developed the TAM to facilitate communication and teamwork between staff in separate spaces during TI and assigned patients to the TAM group (TAM-G). Communication and teamwork were evaluated using the Team Emergency Assessment Measure (TEAM). Subjective evaluations were conducted using a questionnaire administered to medical staff. RESULTS Eighty-nine patients were enrolled: 17, 34, and 38 in the Con-G, Iso-G, and TAM-G, respectively. The communication frequency (CF) of the Con-G and Iso-G was the highest and lowest, respectively. The CF of the TAM-G increased and approached that of the Con-G. The overall TEAM score was the highest in the Con-G and the lowest in the Iso-G, while the overall score in the TAM-G was comparable to that of the Con-G. DISCUSSION The TAM may improve communication and teamwork for TIs without compromising efficacy during the pandemic. This study was registered at ClinicalTrials.gov; registration numbers: NCT04479332 and NCT04591873.
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Affiliation(s)
- Chien-Hao Lin
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Yang Lin
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ni Wu
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Pin Tseng
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Ting Chen
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Tzu Tien
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, 38006National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Weng CH, Kao CL, Chiu PW, Huang SP, Kuo YS, Lin YY, Lin IC, Chang HC, Lu CH, Lin CH. A full-face mask for protection against respiratory infections. Biomed Eng Online 2022; 21:62. [PMID: 36064546 PMCID: PMC9442593 DOI: 10.1186/s12938-022-01027-1] [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: 02/16/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aerosols and droplets are the transmission routes of many respiratory infectious diseases. The COVID-19 management guidance recommends against the use of nebulized inhalation therapy directly in the emergency room or in an ambulance to prevent possible viral transmission. The three-dimensional printing method was used to develop an aerosol inhalation treatment mask that can potentially prevent aerosol dispersion. We conducted this utility validation study to understand the practicability of this new nebulizer mask system. RESULTS The fit test confirmed that the filter can efficiently remove small particles. The different locations of the mask had an excellent fit with a high pressure making a proper face seal usability. The full-face mask appeared to optimize filtration with pressure and is an example of materials that perform well for improvised respiratory protection using this design. The filtering effect test confirmed that the contamination of designated locations could be protected when using the mask with filters. As in the clinical safety test, a total of 18 participants (10 [55.6%] females; aged 33.1 ± 0.6 years) were included in the final analysis. There were no significant changes in SPO2, EtCO2, HR, SBP, DBP, and RR at the beginning, 20th, 40th, or 60th minutes of the test (all p >.05). The discomfort of wearing a mask increased slightly after time but remained within the tolerable range. The vision clarity score did not significantly change during the test. The mask also passed the breathability test. CONCLUSION The results of our study showed that this mask performed adequately in the fit test, the filtering test, and the clinical safety test. The application of a full-face mask with antiviral properties, together with the newly designed shape of a respirator that respects the natural curves of a human face, will facilitate the production of personal protective equipment with a highly efficient filtration system. METHODS We conducted three independent tests in this validation study: (1) a fit test to calculate the particle number concentration and its association with potential leakage; (2) a filtering effect test to verify the mask's ability to contain aerosol spread; and (3) a clinical safety test to examine the clinical safety, comfortableness, and visual clarity of the mask.
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Affiliation(s)
- Chen-Hsun Weng
- Medical Device Innovation Center, National Cheng Kung University, No. 138, Shengli Rd., North District, Tainan, 70403, Taiwan
| | - Chia-Lung Kao
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Chen Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Pandian V, Hopkins BS, Yang CJ, Ward E, Sperry ED, Khalil O, Gregson P, Bonakdar L, Messer J, Messer S, Chessels G, Bosworth B, Randall DM, Freeman-Sanderson A, McGrath BA, Brenner MJ. Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection. Am J Otolaryngol 2022; 43:103525. [PMID: 35717856 PMCID: PMC9172276 DOI: 10.1016/j.amjoto.2022.103525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.
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Affiliation(s)
- Vinciya Pandian
- Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, United States of America; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States of America.
| | - Brandon S Hopkins
- Department of Otolaryngology, Head and Neck Surgery, The Cleveland Clinic, Cleveland, OH, United States of America.
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, NY, United States of America.
| | - Erin Ward
- Global Tracheostomy Collaborative, Raleigh, NC, United States of America; Family Liaison, Multidisciplinary Tracheostomy Team, Boston Children's Hospital, Boston, MA, United States of America; MTM-CNM Family Connection, Inc., Methuen, MA, United States of America(1)
| | - Ethan D Sperry
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Ovais Khalil
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America.
| | - Prue Gregson
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Lucy Bonakdar
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Jenny Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Sally Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Gabby Chessels
- Austin Health Tracheostomy Patient & Family Forum, Tracheostomy Review and Management Services, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia.
| | | | - Diane M Randall
- Memorial Regional Health System, Fort Lauderdale, FL, United States of America.
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| | - Brendan A McGrath
- Anaesthesia & Intensive Care Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, United States of America; Global Tracheostomy Collaborative, Raleigh, NC, United States of America.
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Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Francis T, Verbeek JH. Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare providers. Cochrane Database Syst Rev 2022; 8:CD013826. [PMID: 35994295 PMCID: PMC9394685 DOI: 10.1002/14651858.cd013826.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aerosols and spatter are generated in a dental clinic during aerosol-generating procedures (AGPs) that use high-speed hand pieces. Dental healthcare providers can be at increased risk of transmission of diseases such as tuberculosis, measles and severe acute respiratory syndrome (SARS) through droplets on mucosae, inhalation of aerosols or through fomites on mucosae, which harbour micro-organisms. There are ways to mitigate and contain spatter and aerosols that may, in turn, reduce any risk of disease transmission. In addition to personal protective equipment (PPE) and aerosol-reducing devices such as high-volume suction, it has been hypothesised that the use of mouth rinse by patients before dental procedures could reduce the microbial load of aerosols that are generated during dental AGPs. OBJECTIVES To assess the effects of preprocedural mouth rinses used in dental clinics to minimise incidence of infection in dental healthcare providers and reduce or neutralise contamination in aerosols. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 4 February 2022. SELECTION CRITERIA We included randomised controlled trials and excluded laboratory-based studies. Study participants were dental patients undergoing AGPs. Studies compared any preprocedural mouth rinse used to reduce contaminated aerosols versus placebo, no mouth rinse or another mouth rinse. Our primary outcome was incidence of infection of dental healthcare providers and secondary outcomes were reduction in the level of contamination of the dental operatory environment, cost, change in mouth microbiota, adverse events, and acceptability and feasibility of the intervention. DATA COLLECTION AND ANALYSIS Two review authors screened search results, extracted data from included studies, assessed the risk of bias in the studies and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data MAIN RESULTS: We included 17 studies with 830 participants aged 18 to 70 years. We judged three trials at high risk of bias, two at low risk and 12 at unclear risk of bias. None of the studies measured our primary outcome of the incidence of infection in dental healthcare providers. The primary outcome in the studies was reduction in the level of bacterial contamination measured in colony-forming units (CFUs) at distances of less than 2 m (intended to capture larger droplets) and 2 m or more (to capture droplet nuclei from aerosols arising from the participant's oral cavity). It is unclear what size of CFU reduction represents a clinically significant amount. There is low- to very low-certainty evidence that chlorhexidine (CHX) may reduce bacterial contamination, as measured by CFUs, compared with no rinsing or rinsing with water. There were similar results when comparing cetylpyridinium chloride (CPC) with no rinsing and when comparing CPC, essential oils/herbal mouthwashes or boric acid with water. There is very low-certainty evidence that tempered mouth rinses may provide a greater reduction in CFUs than cold mouth rinses. There is low-certainty evidence that CHX may reduce CFUs more than essential oils/herbal mouthwashes. The evidence for other head-to-head comparisons was limited and inconsistent. The studies did not provide any information on costs, change in micro-organisms in the patient's mouth or adverse events such as temporary discolouration, altered taste, allergic reaction or hypersensitivity. The studies did not assess acceptability of the intervention to patients or feasibility of implementation for dentists. AUTHORS' CONCLUSIONS: None of the included studies measured the incidence of infection among dental healthcare providers. The studies measured only reduction in level of bacterial contamination in aerosols. None of the studies evaluated viral or fungal contamination. We have only low to very low certainty for all findings. We are unable to draw conclusions regarding whether there is a role for preprocedural mouth rinses in reducing infection risk or the possible superiority of one preprocedural rinse over another. Studies are needed that measure the effect of rinses on infectious disease risk among dental healthcare providers and on contaminated aerosols at larger distances with standardised outcome measurement.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Professor and Head, Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
- Honorary Research Fellow, Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London, London, UK
| | - Prashanti Eachempati
- Professor and Head, Department of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Martha Paisi
- Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Mona Nasser
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Tony Francis
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Jos H Verbeek
- Cochrane Work, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Itoh N, Akazawa N, Ishikane M, Kawabata T, Kawamura D, Chikusa T, Kodama EN, Ohmagari N. Lessons learned from an outbreak of COVID-19 in the head and neck surgery ward of a Japanese cancer center during the sixth wave by Omicron. J Infect Chemother 2022; 28:1610-1615. [PMID: 35995417 PMCID: PMC9389781 DOI: 10.1016/j.jiac.2022.08.010] [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: 03/21/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
Introduction We describe a coronavirus disease (COVID-19) outbreak in a cancer center's head and neck surgery ward and the interventions to halt ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers and patients with cancer. Methods Case definition included all healthcare workers and all patients associated to the ward from January 27 to January 31, 2022 with a positive SARS-COV-2 antigen test. This retrospective descriptive study was conducted between January 27, 2022, and February 14, 2022. Results From January 28, 2022, to February 9, 2022, 84 cases (36 healthcare workers, 48 patients) were screened, and 26 (12 healthcare workers, 14 patients) were identified as SARS-CoV-2-positive. The proportion of healthcare providers who performed aerosol generating procedures on positive patients was 91% for positive cases and 49% for non-cases. Room sharing with patients with COVID-19 was 64% for positive cases and 21% for non-cases (57% vs. 21% with positive tracheostomy patients; 43% vs. 9% with positive cases using a nebulizer; 50% vs. 15% with positive cases requiring sputum suctioning, respectively). Compliance with the universal masking policy for patients was 36% of positive cases and 79% of non-cases. Conclusions This is the first report of a nosocomial outbreak of COVID-19 in a head and neck surgery ward during the Omicron pandemic. Notably, there were a high number of positive cases among healthcare workers who performed aerosol generating procedures for positive patients and patients who shared the room with a patient with COVID-19 with the potential to generate aerosols.
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Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
| | - Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Daichi Kawamura
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Tomoyuki Chikusa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Eiichi N Kodama
- Division of Infectious Diseases, International Research Institute of Disaster Science, Graduate School of Medicine, Tohoku University and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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Affiliation(s)
- Jason Chui
- Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Canada
| | - David Sc Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Matthew Tv Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
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Leal J, Farkas B, Mastikhina L, Flanagan J, Skidmore B, Salmon C, Dixit D, Smith S, Tsekrekos S, Lee B, Vayalumkal J, Dunn J, Harrison R, Cordoviz M, Dubois R, Chandran U, Clement F, Bush K, Conly J, Larios O. Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review. Antimicrob Resist Infect Control 2022; 11:102. [PMID: 35953854 PMCID: PMC9366810 DOI: 10.1186/s13756-022-01133-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/27/2022] [Indexed: 02/08/2023] Open
Abstract
Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2–3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation. Conclusion Exposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01133-8.
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Jimenez JL, Marr LC, Randall K, Ewing ET, Tufekci Z, Greenhalgh T, Tellier R, Tang JW, Li Y, Morawska L, Mesiano‐Crookston J, Fisman D, Hegarty O, Dancer SJ, Bluyssen PM, Buonanno G, Loomans MGLC, Bahnfleth WP, Yao M, Sekhar C, Wargocki P, Melikov AK, Prather KA. What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic? INDOOR AIR 2022; 32:e13070. [PMID: 36040283 PMCID: PMC9538841 DOI: 10.1111/ina.13070] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 05/05/2023]
Abstract
The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.
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Affiliation(s)
- Jose L. Jimenez
- Department of Chemistry and Cooperative Institute for Research in Environmental SciencesUniversity of ColoradoBoulderColoradoUSA
| | - Linsey C. Marr
- Department of Civil and Environmental EngineeringVirginia TechBlacksburgVirginiaUSA
| | | | | | - Zeynep Tufekci
- School of JournalismColumbia UniversityNew YorkNew YorkUSA
| | - Trish Greenhalgh
- Department of Primary Care Health SciencesMedical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Julian W. Tang
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Yuguo Li
- Department of Mechanical EngineeringUniversity of Hong KongHong KongChina
| | - Lidia Morawska
- International Laboratory for Air Quality and HeathQueensland University of TechnologyBrisbaneQueenslandAustralia
| | | | - David Fisman
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Orla Hegarty
- School of Architecture, Planning & Environmental PolicyUniversity College DublinDublinIreland
| | - Stephanie J. Dancer
- Department of MicrobiologyHairmyres Hospital, Glasgow, and Edinburgh Napier UniversityGlasgowUK
| | - Philomena M. Bluyssen
- Faculty of Architecture and the Built EnvironmentDelft University of TechnologyDelftThe Netherlands
| | - Giorgio Buonanno
- Department of Civil and Mechanical EngineeringUniversity of Cassino and Southern LazioCassinoItaly
| | - Marcel G. L. C. Loomans
- Department of the Built EnvironmentEindhoven University of Technology (TU/e)EindhovenThe Netherlands
| | - William P. Bahnfleth
- Department of Architectural EngineeringThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Maosheng Yao
- College of Environmental Sciences and EngineeringPeking UniversityBeijingChina
| | - Chandra Sekhar
- Department of the Built EnvironmentNational University of SingaporeSingaporeSingapore
| | - Pawel Wargocki
- Department of Civil EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Arsen K. Melikov
- Department of Civil EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Kimberly A. Prather
- Scripps Institution of OceanographyUniversity of California San DiegoLa JollaCaliforniaUSA
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Duarte-Medrano G, Sorbello M, Susunaga-Hope RR, Fuentes-Castro PI, Avila-OrtIz BC, Velasco-Godinez AP, Contreras-Garcia WY, Pineda-Castillo MA, Urdaneta F, Téllez-Ávila FI. Aerosol boxes for airway management in coronavirus disease patients: a clinical retrospective study in Mexico. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:32. [PMID: 37386573 DOI: 10.1186/s44158-022-00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Significant concerns raise for the healthcare workers involved in airway management of patients diagnosed with coronavirus 2019 disease (COVID-19). Due to shortages of personal protective equipment (PPE), barrier enclosure systems such as aerosol box (AB) have been proposed worldwide. The aim of this study was to evaluate our experience using AB as protective equipment in patients with COVID-19 in a third-level center in Mexico. METHODS A retrospective study of COVID-19 patients requiring airway management using an AB in the Hospital Central Sur de Alta Especialidad de Pemex in Mexico City from March 1 to June 1, 2020. Antropometric data, pre-intubation vital signs, and laboratory tests were recorded; the primary endpoints were intubation success rate and complications associated with AB and patients' mortality. As a secondary endpoint, AB subjective evaluation was explored by administering a survey after airway management procedures. RESULTS Thirty-nine patients for a total of 40 intubations were documented. Thirty-one (77.5%) were men, with a mean age of 61.65 years; successful intubation occurred in 39 (97.55%) of the procedures, and AB was used in 36 (90%) of intubations, with success in 28 (70.0%); A Cormack-Lehane grade 3 view was recorded in 18 patients (46.2%), and during the procedure, the AB had to be removed in 8 (22.2%) cases, with migration documented in 91.6% of cases. The 30-day mortality was 48.71%, with 23.0% of patients discharged. 83.3% of surveyed anesthesiologists reported significant limitations in manipulating airway devices with AB used. CONCLUSION Our data indicate that in clinical practice, the use of AB may hinder airway management and decrease the intubation success rate and may also result in patients' injury. Further studies are necessary to validate the use of AB in clinical practice, and they should not replace certified PPE.
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Affiliation(s)
- Gilberto Duarte-Medrano
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | - Massimiliano Sorbello
- Anaesthesia, and Intensive Care, Policlinico San Marco University Hospital, Viale C. A. Ciampi, 95100, Catania, Italy.
| | | | | | - Beatriz C Avila-OrtIz
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Wendy Y Contreras-Garcia
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Felipe Urdaneta
- Clinical Professor Anesthesiology, Department of Anesthesiology, University of Florida/NFSGVHS, Florida, USA
| | - Félix Ignacio Téllez-Ávila
- Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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The impact of coronavirus disease 2019 on the head and neck cancer pathway in the West of Scotland. The Journal of Laryngology & Otology 2022; 136:535-539. [DOI: 10.1017/s0022215122000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe coronavirus disease 2019 pandemic has greatly disrupted head and neck cancer services in the West of Scotland. This study aimed to assess the impact of the first wave of the pandemic on cancer waiting times.MethodsA retrospective review of multidisciplinary team records was undertaken between March and May in 2019 and the same months in 2020. Time-to-diagnosis and time-to-treatment for new cancers treated with curative intent were compared between the study periods, and subclassified by referral pathway.ResultsA total of 236 new cancer patients were included. During the pandemic, pathways benefitted from reduced diagnostic and treatment times resulting from the restructuring of service provisions. A 75 per cent reduction in secondary care referrals and a 33 per cent increase in urgent suspicion of cancer referrals were observed in 2020.ConclusionHead and neck cancer pathway times did not suffer because of the coronavirus pandemic. Innovations introduced to mitigate issues brought about by coronavirus benefitted patients, led to a more streamlined service, and improved diagnostic and treatment target compliance.
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Virant FS, Randolph C, Nanda A, Baptist AP, Akuthota P, Adams K, Quinn JM, Pongdee T, Nyenhuis SM. Pulmonary Procedures During the COVID-19 Pandemic: A Work Group Report of the AAAAI Asthma Diagnosis and Treatment (ADT) Interest Section. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:1474-1484. [PMID: 35431153 PMCID: PMC9009724 DOI: 10.1016/j.jaip.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic has placed increased demands on the ability to safely perform pulmonary procedures in keeping with Centers for Disease Control and Prevention (CDC), American Thoracic Society (ATS), and the Occupational Safety and Health Administration (OSHA) recommendations. Accordingly, the American Academy of Allergy, Asthma & Immunology (AAAAI) Asthma Diagnosis and Treatment convened this work group to offer guidance. The work group is composed of specialist practitioners from academic and both large and small practices. Individuals with special expertise were assigned sections on spirometry, fractional exhaled nitric oxide, nebulized treatments, and methacholine challenge. The work group met periodically to achieve consensus. This resulting document has recommendations for the allergy/asthma/immunology health care setting based on available evidence including reference documents from the CDC, ATS, and OSHA.
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Early Nurse Management Experiences from Finnish COVID-19 Hubs: An In-Action Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084885. [PMID: 35457757 PMCID: PMC9031167 DOI: 10.3390/ijerph19084885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
Primary healthcare (PHC) clinics are the point of access for many COVID-19 patients; however, the focus of crisis response work has been in securing hospital capacities. The purpose of this study was to describe the early nurse management experiences from PHC clinics within Greater Helsinki dedicated to caring for all ambulatory patients with possible COVID-19 symptoms. The study objectives were to make PHC crisis response contributions known and to provide an in-action review (IAR) of crisis response efforts. Nurse managers from the four COVID-19 hubs in Greater Helsinki were interviewed using thematic pair interviews. The data were analyzed inductively using thematic analysis, by which four main themes emerged: (1) capacity development led to a state of flux, (2) infection prevention control (IPC) was critical, (3) management of staff was essential in facilitating crisis response, and (4) respondents’ personal experiences. The state of flux stressed the provision of PHC services, but quick developments in telemedicine eased that burden. Conversation surrounding IPC was extensive, though discrepancies suggest that global efforts to standardize IPC practices must begin locally. Leadership was adjusted to accommodate for the crisis, especially regarding the motivation of staff. A vision to aspire toward in crisis recovery is needed.
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