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Temmesfeld MJ, Gorzkowska-Sobas AA, Hedlund K, Øyen MØ, Kanten L, Grant P, Jakobsen RB. Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators. Am J Infect Control 2022; 50:624-630. [PMID: 34958857 DOI: 10.1016/j.ajic.2021.12.002] [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: 10/30/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Filtering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs. METHODS Four critical features were investigated close to regulatory requirements: total inward leakage of particles, CO2 concentrations, intra-helmet differential pressure, and automated disinfection. RESULTS The average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO2 concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine. DISCUSSION The modified SH provides several hundred times better protection than FFP-3 masks. CONCLUSIONS Surgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.
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Affiliation(s)
- Max Joachim Temmesfeld
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway.
| | | | | | | | - Lars Kanten
- Department of Sterile Supplies, Akershus University Hospital, Lørenskog, Norway
| | - Peter Grant
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gotehnburg, Sweden; Lovisenberg Diaconal Hospital, Nydalen, Oslo, Norway
| | - Rune B Jakobsen
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
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Aerosol morphology and particle size distribution in orthopaedic bone machining: a laboratory worst-case contamination simulation. Is high-speed bone machining potentially harmful by pollution and quality schemes and what measures could be taken for prevention? INTERNATIONAL ORTHOPAEDICS 2022; 46:1647-1655. [PMID: 35435476 PMCID: PMC9013979 DOI: 10.1007/s00264-022-05398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
Aim of the study High-speed bone machining devices with irrigation fluid were used in surgery to spread aerosols and toss tissue particles of varying morphology into the operating room. Based on measurements taken on a phantom object, the shape, size, and spatial contamination distribution of such particles were assessed. Method Cadaveric femoral heads were continuously machined with a spherical bur, manually held at a fixed attack angle. The irrigation fluid used during bone machining was enriched with bacteria to act as a tracer to quantify the spatial contamination. A vertical board equipped with snippets served as a phantom object to assess contamination load and morphology of airborne particles. Results Eight-nine percent of the particles had a non-circular cross section. The detected particle size ranged across six orders of magnitude, from 0.006 to 4 mm2 with a median particle size of 0.125 mm2. The CFU counts observed after the standard machining time ranged from 7 to 240, with a median of 2 CFUs. The highest median contamination was seen at the upper right corner of the phantom. Discussion The experiments show that contaminating particles of a wide variety of shapes and sizes are part of the aerosol created by high-speed burring. While protection of personnel and equipment is always important, surgical helmets should be worn, especially at contamination hotspots, and gloves should be replaced at the end of machining. Sensitive instruments and measuring devices—such as optical sensors—should also be protected effectively, as the optical measurement may be obstructed by aerosol particles.
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Occupational Hazards for the Practicing Orthopaedic Surgeon: A Standard Review. J Am Acad Orthop Surg 2022; 30:e607-e616. [PMID: 35171850 DOI: 10.5435/jaaos-d-21-00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/06/2021] [Indexed: 02/01/2023] Open
Abstract
Level V.
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Gasparini G, Castioni D, Spina G, Familiari F, Galasso O, Mercurio M. The use of a surgical helmet system with a high-efficiency particulate air filter as possible protection equipment during the coronavirus disease 2019 pandemic: a double-blinded randomized control study. INTERNATIONAL ORTHOPAEDICS 2022; 46:1233-1240. [PMID: 35292837 PMCID: PMC8923968 DOI: 10.1007/s00264-022-05371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The rapid spread of coronavirus disease 2019 (COVID-19) has increased the use of personal protective equipment. The purpose of this study was to investigate whether a commercially available sterile surgical helmet system (SSHS) can be considered protective against COVID-19 and therefore safe for use. METHODS A double-blinded randomized controlled study was performed to investigate the efficacy of the ViVi® SSHS with a high-efficiency particulate air filter called HFD Hood (THI, Total Healthcare Innovation GmbH, Feistritz im Rosental, Austria) to protect against respiratory droplets. Forty recruited participants were divided into two different groups. The SSHS was tested using a validated qualitative test for respirator masks through saccharin or placebo solutions based on random allocation into two cohorts. Saccharin droplets are a validated surrogated marker for any elements of viral size, such as coronaviruses. A positive report of sweet taste after saccharin exposure was suggestive of ViVi® SSHS inefficacy in protection against droplets. RESULTS One participant out of 21 (4.8%) reported positive for taste within the placebo cohort, while five out of 19 (26.3%) reported positive for taste within the saccharin cohort upon testing. Two out of 21 (9.5%) participants reported positive for taste within the placebo cohort, and two out of 19 (10.5%) reported positive for taste within the saccharin cohort upon retesting. There were no statistically significant differences between the saccharin and placebo groups in either the test or retest measurements (p = 0.085 and p = 1.000, respectively). CONCLUSIONS This study demonstrates that the ViVi® SSHS equipped with HFD Hood protects against respiratory droplets, increasing protection against several microorganisms, including the virus that causes COVID-19, allowing surgeons to carry out procedures on COVID-positive patients in a more comfortable and safer way.
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Affiliation(s)
- Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy.
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.Le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy
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Kessel J, Saevig CS, Hill WC, Kessel B, Hull MS. An Emergency Powered Air-Purifying Respirator From Local Materials and its Efficacy Against Aerosolized Nanoparticles. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221087837. [PMID: 35341353 PMCID: PMC8961371 DOI: 10.1177/00469580221087837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe an approach used by a rural healthcare provider to convert surgical
helmets into emergency powered air-purifying respirators (PAPRs) at the onset of
the COVID-19 pandemic. The approach uses common materials and efficacy was
demonstrated against aerosols measuring 7 nm to 25 μm in diameter.
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Affiliation(s)
| | | | | | | | - Matthew S. Hull
- NanoSafe, Inc, Blacksburg, VA, USA
- Virginia Tech, Blacksburg, VA, USA
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Jaly I, Iyengar KP, Bahl S, Jain V, Vaishya R. COVID-19 Pandemic and Debates on the Design of Operating Theatre Ventilation Systems in Healthcare Facilities. JOURNAL OF INDUSTRIAL INTEGRATION AND MANAGEMENT 2021. [DOI: 10.1142/s2424862221500093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
COVID-19 pandemic had a significant impact on providing Trauma and Orthopedic surgery around the world. The orthopedic community had to reconfigure emergency and urgent trauma services safely but also support strategies to prevent person-to-person coronavirus transmission. Various organizations including British Orthopedic Association (BOA), American Academy of Orthopedic Surgeons (AAOS) and Public Health England (PHE) have provided guidelines for conducting safe essential surgery in operating theatres. One of the areas that have not been debated enough is the type of ventilation systems that should be used in operating theatres during this global pandemic. We review the current evidence in the literature particularly in the challenges faced by health care professionals in current COVID-19 pandemic in deciding and implementing an effective operating theatre ventilation system protecting both our patients and operating room personnel.
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Affiliation(s)
- Ibrahim Jaly
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport PR8 6PN United Kingdom
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport PR8 6PN United Kingdom
| | - Shashi Bahl
- Department of Mechanical Engineering, I.K. Gujral Punjab Technical University, Hoshiarpur Campus, Hoshiarpur 146001, India
| | - Vijay Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar, Lohia Hospital, New Delhi 110001, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110076, India
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Shah D, Sahu D, Kini A, Bagaria V. Improvising the surgical helmet system for aerosol-generating procedures in the OR: Surgeon designed 3D printed mould for augmented filtration system. J Clin Orthop Trauma 2021; 12:27-32. [PMID: 32994683 PMCID: PMC7515591 DOI: 10.1016/j.jcot.2020.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 01/06/2023] Open
Abstract
1 BACKGROUND The aim of this paper is to describe the process of designing and developing a mould for filter placement via 3D printing on top of the surgical helmet. This mould was designed to affix a filter material on top of the helmet system for use during the COVID - 19 pandemic. 2 METHOD The authors performed 3D scanning of the Stryker Surgical helmet (Stryker T5, REF 400-610, US patents 6,973,677:7,753,682) and created a negative template of the top of the helmet. A mould for filter placement was printed and fitted onto the top of the surgical helmet. This construct was tested to evaluate the surgeon's comfort, aerosol filtration efficiency etc. 3 RESULT The helmet provided adequate comfort, showed no evidence of staining on spill test and the filter passed the industry filtration efficiency standards. 4 CONCLUSION The 3D printed mould is an inexpensive, efficient, and comfortable design to augment personal protection ability of the Stryker helmet system. This process can be extrapolated to 3D print templates for other surgical helmets.
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Affiliation(s)
- Darshil Shah
- Department of Orthopaedic, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Dipit Sahu
- Department of Orthopaedic, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Abhishek Kini
- Department of Orthopaedic, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Vaibhav Bagaria
- Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Prarthana Samaj, Raja Rammohan Roy Rd, Girgaon, Mumbai, Maharashtra, 400004, India,Corresponding author.
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Carter J, Doorgakant A, Rigby M, Robb C. A space suit modification for the COVID-19 era. Ann R Coll Surg Engl 2020; 102:756-757. [DOI: 10.1308/rcsann.2020.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J Carter
- Warrington Hospital, Warrington, UK
| | | | - M Rigby
- Warrington Hospital, Warrington, UK
| | - C Robb
- Warrington Hospital, Warrington, UK
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Gibbons JP, Hayes J, Skerritt CJ, O'Byrne JM, Green CJ. Custom solution for personal protective equipment (PPE) in the orthopaedic setting: retrofitting Stryker Flyte T5 PPE system. J Hosp Infect 2020; 108:55-63. [PMID: 33122042 PMCID: PMC7587078 DOI: 10.1016/j.jhin.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
The coronavirus disease 2019 pandemic has meant that there is growing pressure on hospital resources, not least the availability of appropriate personal protective equipment (PPE), particularly face masks and respirator masks. Within the field of orthopaedic surgery, it is a common sight to see surgeons wearing ‘space suits’ (SSs) which comprise a helmet, hood and surgical gown. In this study, the authors made modifications to two different SS systems to incorporate a high-efficiency particulate air (HEPA) filter into the fan inlet to assess their potential as re-usable PPE systems for surgeons with regard to protection from a virus spread via respiratory droplets. The testing was carried out using particle counters upstream and downstream on a mannequin wearing two different SS systems with and without modifications to the fan inlet. The results show that using a layer of HEPA filter, cut to size and sealed to the fan inlet in the helmet, will reduce downstream particulates at the user's mouth by >99.5%; this is equivalent to a respirator mask. HEPA filter material is relatively cheap and can be used repeatedly, making this a viable alternative to disposable, and even resterilized, respirator masks in the setting of a respiratory-droplet-spread viral pandemic.
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Affiliation(s)
- J P Gibbons
- Department of Trauma and Orthopaedic Surgery, National Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland.
| | - J Hayes
- Department of Trauma and Orthopaedic Surgery, National Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland
| | - C J Skerritt
- Department of Anaesthesia, National Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland
| | - J M O'Byrne
- Department of Trauma and Orthopaedic Surgery, National Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland
| | - C J Green
- Department of Trauma and Orthopaedic Surgery, National Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland; Department of Trauma and Orthopaedic Surgery, Children's University Hospital, Dublin, Ireland
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A new role for orthopaedic surgeons: ongoing changes, lessons learned, and perspectives from a level I trauma center during the COVID-19 pandemic. J Shoulder Elbow Surg 2020; 29:1951-1956. [PMID: 32738400 PMCID: PMC7390768 DOI: 10.1016/j.jse.2020.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic has redefined global health care. With almost 13 million confirmed cases worldwide, medical professionals have been forced to modify their practice to take care of an expanded, critically ill population. Institutions have been challenged to implement innovative ways to maximize the utility and the safety of residents and personnel. Guided by lessons learned from prior mass causalities, wars, and previous pandemics, adjustments have been made in order to provide optimal care for all patients while still protecting limited resources and the lives of health care workers. Specialists who are trained in the management of lethal aspects of this disease continue to have a high demand and obvious role. Orthopedic surgeons, with ill-defined roles, have been redeployed to manage complex medical problems. Still, the need to manage trauma, fractures, infections, tumors, and dislocations remains a necessity. Various innovative measures have been taken to maximize the utility and safety of residents in the inpatient and outpatient setting. Commonalities to most measures and distinct changes in practice philosophy can be identified and applied to both current and future pandemic responses.
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Abstract
Background and purpose - The COVID-19 pandemic caused by infection with SARS-CoV-2 has led to a global shortage of personal protective equipment (PPE). Various alternatives to ordinary PPE have been suggested to reduce transmission, which is primarily through droplets and aerosols. For many years orthopedic surgeons have been using surgical helmets as personal protection against blood-borne pathogens during arthroplasty surgery. We have investigated the possibility of using the Stryker Flyte surgical helmet as a respiratory protective device against airborne- and droplet-transmitted disease, since the helmet shares many features with powered air-purifying respirators.Materials and methods - Using an aerosol particle generator, we determined the filtration capacity of the Stryker Flyte helmet by placing particle counters measuring the concentrations of 0.3, 0.5, and 5 µm particles inside and outside of the helmet.Results - We found that the helmet has insufficient capacity for filtrating aerosol particles, and, for 0.3 µm sized particles, we even recorded an accumulation of particles inside the helmet.Interpretation - We conclude that the Stryker Flyte surgical helmet should not be used as a respiratory protective device when there is a risk for exposure to aerosol containing SARS-CoV-2, the virus causing COVID-19, in accordance with the recommendation from the manufacturer.
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Affiliation(s)
- Max Joachim Temmesfeld
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Correspondence:
| | - Rune Bruhn Jakobsen
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Norway;
| | - Peter Grant
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Sweden; ,Lovisenberg Diaconal Hospital, Oslo, Norway
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Leitao DJ, Jones JLP. Pediatric rigid bronchoscopy and foreign body removal during the COVID-19 pandemic: case report. J Otolaryngol Head Neck Surg 2020; 49:66. [PMID: 32928308 PMCID: PMC7487441 DOI: 10.1186/s40463-020-00464-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered.
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Affiliation(s)
- Darren Jonathan Leitao
- Department of Otolaryngology-Head and Neck Surgery, Rady College of Medicine, University of Manitoba, Room GB421-820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| | - Jodi L P Jones
- Department of Otolaryngology-Head and Neck Surgery, Rady College of Medicine, University of Manitoba, Room GB421-820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
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Schaller G, Nayar SK, Erotocritou M, Overton A, Stelzhammer T, Berber O. Efficacy of surgical helmet systems for protection against COVID-19: a double-blinded randomised control study. INTERNATIONAL ORTHOPAEDICS 2020; 45:39-42. [PMID: 32895744 PMCID: PMC7476793 DOI: 10.1007/s00264-020-04796-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022]
Abstract
Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with additional protection from aerosol pathogens alongside their traditional role protecting against splash. There has been debate on whether to use such systems in reopening elective orthopaedic surgery during the current COVID-19 pandemic environment. Methods Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented a failure of the test. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically significant difference in mean time-to-taste saccharin (p = 0.049) comparing fan on (123.5 s) vs. off (62.6 s). Conclusions SSHS do not protect against aerosol particulate and therefore are not efficacious in protection against COVID-19. The fan system employed may even increase risk to the surgeon by drawing in particulates as well as delay recognition of intraoperative cues, such as exhaust from diathermy, that point to respirator mask leak.
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Affiliation(s)
- Gavin Schaller
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK.
| | - Sandeep Krishan Nayar
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Marios Erotocritou
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Alexander Overton
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Onur Berber
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
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Shah VI, Upadhyay S, Shah K, Singh V. COVID-19 pandemic and total knee arthroplasty: the concept of a containment sheet-a frugal innovation. ARTHROPLASTY 2020; 2:23. [PMID: 34977464 PMCID: PMC7449786 DOI: 10.1186/s42836-020-00042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary purpose of the present study was to assess whether use of proposed containment sheet (so called "a frugal innovation") minimizes the aerosol and splatter dispersion during total knee arthroplasty (TKA). MATERIAL AND METHOD A total of 32 patients with knee osteoarthritis who were scheduled to undergo primary and unilateral TKA reported during the COVID-19 pandemic were enrolled into this prospective single-institution cohort study. Demographic and epidemiological data, travel and contact history were collected. Eligible cohort was randomly assigned to a study (TKA using containment sheet) group and a control group (TKA without containment sheet). Radiological and functional outcomes before operation and at the final follow-up were assessed using Western Ontario and Mc-master Universities Osteoarthritis Index score (WOMAC) and the visual analog scale (VAS). The primary outcome was the postoperative effectiveness of containment sheet and face shield, defined as the numbers of countable macroscopic aerosols and/or splatters to naked eyes. The level of significance was set at p < 0.05 levels. RESULTS Present cohort was comprised of 14 men (43.75%) and 18 women (56.25%) with an average age of 65.45 ± 4.07 years (range, 62-75 years). There were no statistically significant differences with regard to baseline parameters and perioperative demographics. Functional outcomes for knee function at the last follow-up showed significant improvement in both the groups (p < 0.05). Face shield showed significant number of aerosols/splatters in control group. Highest number/concentration of aerosols/splatters was contained within the sheet. CONCLUSION The proposed containment sheet can minimize the dispersion of aerosols and splatters generated during TKA and provide a safe healthcare environment in a cost-effective manner.
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Affiliation(s)
- Vikram Indrajit Shah
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
| | - Sachin Upadhyay
- Department of Orthopaedics, NSCB Medical College, Jabalpur, MP India
- Department of Trauma and Knee and Hip Arthroplasty, Shalby Hospitals Jabalpur, Jabalpur, Madhya Pradesh India
| | - Kalpesh Shah
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
| | - Vipin Singh
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
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Acute Care Surgeons' Response to the COVID-19 Pandemic: Observations and Strategies From the Epicenter of the American Crisis. Ann Surg 2020; 272:e66-e71. [PMID: 32675500 PMCID: PMC7268825 DOI: 10.1097/sla.0000000000004028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Navarro RA, Reddy NC, Weiss JM, Yates AJ, Fu FH, McKee M, Lederman ES. Orthopaedic Systems Response to and Return from the COVID-19 Pandemic: Lessons for Future Crisis Management. J Bone Joint Surg Am 2020; 102:e75. [PMID: 32675663 PMCID: PMC7396222 DOI: 10.2106/jbjs.20.00709] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become the dominant health-care issue of this generation and has reached every corner of the health-care delivery spectrum. Our 3 orthopaedic departments enacted a response to the COVID-19 pandemic within our organizations. We discuss our health-care systems' response to the outbreak and offer discussion for the recovery of the orthopaedic service line within large health-care systems.
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Affiliation(s)
| | - Nithin C. Reddy
- Kaiser Permanente Southern California, San Diego, California
| | | | - Adolph J. Yates
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Freddie H. Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael McKee
- University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
- Banner Health, Phoenix Arizona
| | - Evan S. Lederman
- University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
- Banner Health, Phoenix Arizona
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17
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Stinner DJ, Lebrun C, Hsu JR, Jahangir AA, Mir HR. The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure. J Orthop Trauma 2020; 34:333-340. [PMID: 32301767 PMCID: PMC7188036 DOI: 10.1097/bot.0000000000001782] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic has presented challenges to healthcare systems, including the cancellation and then staged resumption of elective procedures. The orthopaedic trauma community has continued to provide care to patients with acute musculoskeletal injuries that cannot be delayed in all scenarios. This article summarizes and provides relevant information (orthopaedic trauma service, outpatient fracture clinic, inpatient surgery) to the practicing orthopaedic traumatologist on maximizing outcomes while limiting exposure during the pandemic. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel J. Stinner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Joseph R. Hsu
- Department of Orthopaedic Surgery, Orthopaedic Surgery, Atrium Health, Charlotte, NC; and
| | - A. Alex Jahangir
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hassan R. Mir
- Department of Orthopaedic Surgery, University of South Florida, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL
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18
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Erickson MM, Richardson ES, Hernandez NM, Bobbert DW, Gall K, Fearis P. Helmet Modification to PPE With 3D Printing During the COVID-19 Pandemic at Duke University Medical Center: A Novel Technique. J Arthroplasty 2020; 35:S23-S27. [PMID: 32354536 PMCID: PMC7166108 DOI: 10.1016/j.arth.2020.04.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/01/2023] Open
Abstract
Care for patients during COVID-19 poses challenges that require the protection of staff with recommendations that health care workers wear at minimum, an N95 mask or equivalent while performing an aerosol-generating procedure with a face shield. The United States faces shortages of personal protective equipment (PPE), and surgeons who use loupes and headlights have difficulty using these in conjunction with face shields. Most arthroplasty surgeons use surgical helmet systems, but in the current pandemic, many hospitals have delayed elective arthroplasty surgeries and the helmet systems are going unused. As a result, the authors have begun retrofitting these arthroplasty helmets to serve as PPE. The purpose of this article is to outline the conception, design, donning technique, and safety testing of these arthroplasty helmets being repurposed as PPE.
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Affiliation(s)
| | | | | | - Dana W Bobbert
- Office of Information Technology, Duke University, Durham, NC
| | - Ken Gall
- Pratt School of Engineering, Duke University, Durham, NC
| | - Paul Fearis
- Pratt School of Engineering, Duke University, Durham, NC
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19
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Ding BTK, Soh T, Tan BY, Oh JYL, Mohd Fadhil MFB, Rasappan K, Lee KT. Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore. J Bone Joint Surg Am 2020; 102:e67. [PMID: 32618915 PMCID: PMC7396219 DOI: 10.2106/jbjs.20.00568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤With severe limitations in manpower, facilities, and equipment, and the concern for nosocomial transmission, operating in a pandemic is fraught with danger from multiple fronts. ➤Strategies to mitigate nosocomial spread include prioritization of existing patients, triaging and treatment of new patient encounters, infection control protocols, perioperative considerations, manpower management, and novel strategies for interdisciplinary interaction and education. ➤The decision to proceed with or postpone surgery should be based on the urgency of the surgical procedure and the physiological health of the patient. ➤When performing an operation on a patient who has suspected or confirmed infection with novel coronavirus disease 2019 (COVID-19), personal protection equipment should include hair covers, face shields or goggles, N95 respirator masks, a blood-borne pathogen-resistant surgical gown, shoe covers, and double-gloving with single-use gloves. ➤Loose-fitting, powered air-purifying respirators should be considered for prolonged surgeries. ➤An astutely formulated and comprehensive business continuity plan is an orthopaedic unit’s best strategy for maintaining critical standards, discipline, and morale in severe and prolonged outbreaks.
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Affiliation(s)
| | - Tamara Soh
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | - Kumaran Rasappan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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20
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Sadigale O, Bagaria V, Vaishya R. Resuming arthroplasty: A well aligned and a balanced approach in the COVID-19 era. J Clin Orthop Trauma 2020; 11:S423-S425. [PMID: 32774005 PMCID: PMC7298514 DOI: 10.1016/j.jcot.2020.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
Returning to Arthroplasty amidst the COVID-19 pandemic requires a well aligned and a balanced approach. Following a set protocol and staged measures are the need of the hour. This article details the specifics for resumption of arthroplasty in the era of COVID19. While formulating the policy for resumption, it is necessary that we consider the following factors: patient's general health status, follow strict guidelines issued by the government, alter and enhance our operating room discipline and last but not the least, leverage technology for optimal patient care and enhanced outcome.
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Affiliation(s)
| | - Vaibhav Bagaria
- Sir H N Reliance Foundation Hospital, Mumbai, India
- Corresponding author. Department of Orthopedics, Sir H N Reliance Foundation Hospital, Mumbai, India.
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21
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Fillingham YA, Grosso MJ, Yates AJ, Austin MS. Personal Protective Equipment: Current Best Practices for Orthopedic Teams. J Arthroplasty 2020; 35:S19-S22. [PMID: 32370924 PMCID: PMC7169903 DOI: 10.1016/j.arth.2020.04.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 02/01/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic caused by the severe acute respiratory syndrome (SARS-CoV-2) virus is challenging healthcare providers across the world. Current best practices for personal protective equipment (PPE) during this time are rapidly evolving and fluid due to the novel and acute nature of the pandemic and the dearth of high-level evidence. Routine infection control practices augmented by airborne precautions are paramount when treating the COVID-19-positive patient. Best practices for PPE use in patients who have unknown COVID-19 status are a highly charged and emotional issue. The variables to be considered include protection of patients and healthcare providers, accuracy and availability of testing, and responsible use of PPE resources. This article also explores the concerns of surgeons regarding possible transmission to their own family members as a result of caring for COVID-19 patients.
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Affiliation(s)
- Yale A. Fillingham
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH,Reprint requests: Yale A. Fillingham, MD, Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
| | - Matthew J. Grosso
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Adolph J. Yates
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew S. Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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22
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Chisari E, Krueger CA, Barnes CL, Van Onsem S, Walter WL, Parvizi J. Prevention of Infection and Disruption of the Pathogen Transfer Chain in Elective Surgery. J Arthroplasty 2020; 35:S28-S31. [PMID: 32389410 PMCID: PMC7175869 DOI: 10.1016/j.arth.2020.04.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 pandemic has caused us all to stop our normal activities and consider how we can safely return to caring for our patients. There are many common practices (such as an increased use of personal protective equipment) which we are all familiar with that can be easily incorporated into our daily routines. Other actions, such as cleaning more surfaces with solutions such as dilute povidone iodine or changing the air filtration systems used within operating room theaters, may require more extensive efforts on our behalf. In this article, we have attempted to highlight some of the changes that arthroplasty surgeons may need to instigate when we are able to resume elective joint arthroplasty procedures in an effort to disrupt the chain of pathogen transfer.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A. Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Stefaan Van Onsem
- The University of Sydney & Northern Local Area Health District (Royal North Shore Hospital), Sydney, Australia
| | - William L. Walter
- The University of Sydney & Northern Local Area Health District (Royal North Shore Hospital), Sydney, Australia
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA,Reprint requests: Javad Parvizi, MD, Rothman Orthopaedic Institute, 125 S 9th Street, Suite 1000, Philadelphia, PA
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23
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Mahlke L, Flohé S, Matthes G, Paffrath T, Wagner F, Wölfl C. [Surgery during the SARS-CoV-2 pandemic : Recommendations on operative procedures]. Unfallchirurg 2020; 123:571-578. [PMID: 32488319 PMCID: PMC7265879 DOI: 10.1007/s00113-020-00830-6] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND In February 2020 Germany was also hit by the SARS-CoV‑2 pandemic. Even patients infected by SARS-CoV‑2 or COVID-19 may need operative procedures. Currently, no uniform recommendations exist on precautions to be taken when operating on these patients. Furthermore, they may differ from one hospital to another. METHODS The task force COVID-19 of the emergency, intensive and severely injured section of the German Trauma Society (DGU e. V.) has developed consensus-based recommendations on surgical treatment of patients with SARS-CoV‑2 infections. Great importance is placed on the implementation in hospitals at all levels of care. RESULTS The indications for surgical interventions in patients with COVID-19 infections require an extremely critical evaluation. When indicated these surgical intervention should ideally be performed in a separate operating theater. All personnel involved should wear personal protective equipment with FFP2 masks, face shields and double gloves. The emergency team in the resuscitation bay should generally wear the same personal protective equipment. Special training is mandatory and the exposure of team members should be minimized. CONCLUSION The recommendations are principally used for all kinds of surgery and comply with the currently available knowledge. Nevertheless, all recommendations represent a compromise between maximum safety of all medical staff and practicability in the routine hospital workflow.
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Affiliation(s)
- Lutz Mahlke
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Vincenz-Krankenhaus GmbH, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Sascha Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtisches Klinikum Solingen GmbH, Solingen, Deutschland
| | - Gerrit Matthes
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Thomas Paffrath
- Sektion Unfallchirurgie, Klinik für Allgemein‑, Viszeral‑, Thorax- und Unfallchirurgie, Krankenhaus der Augustinerinnen gGmbH, Köln, Deutschland
| | - Frithjof Wagner
- Abteilung für septische und rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Christoph Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhausklinikum Hetzelstift, Neustadt an der Weinstraße, Deutschland
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24
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Liang ZC, Chong MSY, Sim MA, Lim JL, Castañeda P, Green DW, Fisher D, Ti LK, Murphy D, Hui JHP. Surgical Considerations in Patients with COVID-19: What Orthopaedic Surgeons Should Know. J Bone Joint Surg Am 2020; 102:e50. [PMID: 32341309 PMCID: PMC7219827 DOI: 10.2106/jbjs.20.00513] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Zhen Chang Liang
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Mark Seng Ye Chong
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Ming Ann Sim
- Department of Anesthesia, National University of Singapore, National University Health System, Singapore
| | - Joel Louis Lim
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Pablo Castañeda
- Department of Pediatric Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Disease, National University Hospital, Singapore
| | - Lian Kah Ti
- Department of Anesthesia, National University of Singapore, National University Health System, Singapore
| | - Diarmuid Murphy
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
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25
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Iorio R, Barnes CL, Vitale MP, Huddleston JI, Haas DA. Total Knee Replacement: The Inpatient-Only List and the Two Midnight Rule, Patient Impact, Length of Stay, Compliance Solutions, Audits, and Economic Consequences. J Arthroplasty 2020; 35:S28-S32. [PMID: 32070657 DOI: 10.1016/j.arth.2020.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In November 2017, CMS finalized the 2018 Medicare Outpatient Prospective Payment System rule that removed TKA from the Medicare inpatient-only (IPO) list. This action had significant and unexpected consequences. METHODS We looked at 3 levels of the IPO rule impact on TKA for Medicare beneficiaries: a national comparison of FFS inpatient and outpatient classification for 2017 vs 2018; a survey of AAHKS surgeons completed in April 2019; and an in-depth analysis of a large academic medical center experience. An analysis of change in admission classification of patients with TKA over time, number of QIO audits, compliance solutions for the new rule, and cost implications of those compliance solutions were evaluated. RESULTS Hospital reimbursement averages $10,122 in an outpatient facility but does not include the physician payment. Average hospital reimbursement in the inpatient setting is $11,760. The difference in hospital reimbursement varies widely (90th percentile decrease, $6725 vs 10th percentile $2048). Physician payments are the same in both settings (avg $1403). Patients with TKA not designated for inpatient admissions are not eligible for bundle payment programs. Patients designated as outpatients are subjected to higher out-of-pocket expenses. Patients may have an annual Medicare Part B Deductible ($185) and a 20% copay as well as prescription and durable medical equipment costs. An AAHKS survey demonstrated that 45.08% were with inpatient designation only, 17.62% were with outpatient designation only, 25.39% were designated as necessary, and 10.1% were designated by the hospital. This survey showed that 66 of 374 (17.65%) patients had undergone a QIO audit as a result of issues with the IPO rule. An evaluation of an AMC demonstrated that since January 1, 2018, 470 of 690 (68.1%) of CMS patients with TKA left in less than 2 midnights. The institution was subjected to 2 QIO audits. CONCLUSIONS There are many unintended consequences to the IPO rule application to TKA.
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Affiliation(s)
- Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - C Lowry Barnes
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Matthew P Vitale
- Department of Hospital Medicine, Brigham and Women's Hospital, Boston, MA
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26
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Yung CSY, Fok KCH, Leung CN, Wong YW. What every orthopaedic surgeon should know about COVID-19: A review of the current literature. J Orthop Surg (Hong Kong) 2020; 28:2309499020923499. [PMID: 32406305 DOI: 10.1177/2309499020923499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The coronavirus (COVID-19) pandemic has severely affected the medical community and stopped the world in its tracks. This review aims to provide the basic information necessary for us, orthopaedic surgeons to prepare ourselves to face this pandemic together. Herein, we cover the background of COVID-19, presentation, investigations, transmission, infection control and touch upon emerging treatments. It is of paramount importance that we should stay vigilant for our patients, our families and ourselves. Adequate infection control measures are necessary during day-to-day clinical work.
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Affiliation(s)
- Colin Shing-Yat Yung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kevin Chi Him Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ching Ngai Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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27
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Ambrosio L, Vadalà G, Russo F, Papalia R, Denaro V. The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives. J Exp Orthop 2020; 7:35. [PMID: 32458150 PMCID: PMC7250587 DOI: 10.1186/s40634-020-00255-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19+ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.
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Affiliation(s)
- Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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28
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Emergency and Urgent Orthopaedic Surgeries in non-covid patients during the COVID 19 pandemic: Perspective from India. J Orthop 2020; 20:275-279. [PMID: 32398903 PMCID: PMC7214338 DOI: 10.1016/j.jor.2020.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To Evaluate the results and the protocols of our Institution for 18 Emergency and Urgent Non Covid Surgeries during the Covid 19 Pandemic Methods 18 patients underwent Emergency and Urgent Orthopaedic Surgeries at institution. The Protocol was Screening, Segregation, Selection, Isolation, theatre modification, and Online Follow. Results Two adverse events including, one death and one intensive care admission due to underlying morbidity were recorded. Average Hospital stay was 2.5 days with no patients becoming covid positive at follow up. Conclusion Strict Surgical protocols need to be followed for surgery during the Covid19 pandemic.
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29
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Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am 2020; 102:946-950. [PMID: 32282412 PMCID: PMC7197341 DOI: 10.2106/jbjs.20.00454] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal,ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal,Email address for R. Rodrigues-Pinto:
| | - Ricardo Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal,ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - António Oliveira
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal,ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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30
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Baldock TE, Bolam SM, Gao R, Zhu MF, Rosenfeldt MPJ, Young SW, Munro JT, Monk AP. Infection prevention measures for orthopaedic departments during the COVID-2019 pandemic: a review of current evidence. Bone Jt Open 2020; 1:74-79. [PMID: 33215110 PMCID: PMC7659659 DOI: 10.1302/2633-1462.14.bjo-2020-0018.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff. METHODS A search of Medline, EMBASE, the Cochrane Library, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) databases was performed encompassing a variety of terms including 'coronavirus', 'covid-19', 'orthopaedic', 'personal protective environment' and 'PPE'. Online database searches identified 354 articles. Articles were included if they studied any of the other coronaviruses or if the basic science could potentially applied to COVID-19 (i.e. use of an inactivated virus with a similar diameter to COVID-19). Two reviewers independently identified and screened articles based on the titles and abstracts. 274 were subsequently excluded, with 80 full-text articles retrieved and assessed for eligibility. Of these, 66 were excluded as they compared personal protection equipment to no personal protection equipment or referred to prevention measures in the context of bacterial infections. RESULTS There is a paucity of high quality evidence surrounding COVID-19. This review collates evidence from previous coronavirus outbreaks to put forward recommendations for orthopaedic surgeons during the COVID-19 pandemic. The key findings have been summarized and interpreted for application to the orthopaedic operative setting. CONCLUSION For COVID-19 positive patients, minimum suggested PPE includes N95 respirator, goggles, face shield, gown, double gloves, and surgical balaclava.Space suits not advised.Be trained in the correct technique of donning and doffing PPE.Use negative pressure theatres if available.Minimize aerosolization and its effects (smoke evacuation and no pulse lavage).Minimize further unnecessary patient-staff contact (dissolvable sutures, clear dressings, split casts).
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Affiliation(s)
- Thomas E. Baldock
- Department of Orthopaedics, Auckland City Hospital, Grafton, New Zealand
| | - Scott M. Bolam
- Department of Orthopaedics, Auckland City Hospital, Grafton, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Ryan Gao
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Mark F. Zhu
- Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | | | - Simon W. Young
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Jacob T. Munro
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
| | - A. Paul Monk
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
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31
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Tompkins BM, Kerchberger JP. Special article: personal protective equipment for care of pandemic influenza patients: a training workshop for the powered air purifying respirator. Anesth Analg 2010; 111:933-45. [PMID: 20810676 DOI: 10.1213/ane.0b013e3181e780f8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Virulent respiratory infectious diseases may present a life-threatening risk for health care professionals during aerosol-generating procedures, including endotracheal intubation. The 2009 Pandemic Influenza A (H1N1) brings this concern to the immediate forefront. The Centers for Disease Control and Prevention have stated that, when performing or participating in aerosol-generating procedures on patients with virulent contagious respiratory diseases, health care professionals must wear a minimum of the N95 respirator, and they may wish to consider using the powered air purifying respirator (PAPR). For influenza and other diseases transmitted by both respiratory and contact modes, protective respirators must be combined with contact precautions. The PAPR provides 2.5 to 100 times greater protection than the N95, when used within the context of an Occupational Safety and Health Administration-compliant respiratory protection program. The relative protective capability of a respirator is quantified using the assigned protection factor. The level of protection designated by the APF can only be achieved with appropriate training and correct use of the respirator. Face seal leakage limits the protective capability of the N95 respirator, and fit testing does not assure the ability to maintain a tight face seal. The protective capability of the PAPR will be defeated by improper handling of contaminated equipment, incorrect assembly and maintenance, and improper don (put on) and doff (take off) procedures. Stress, discomfort, and physical encumbrance may impair performance. Acclimatization through training will mitigate these effects. Training in the use of PAPRs in advance of their need is strongly advised. "Just in time" training is unlikely to provide adequate preparation for groups of practitioners requiring specialized personal protective equipment during a pandemic. Employee health departments in hospitals may not presently have a PAPR training program in place. Anesthesia and critical care providers would be well advised to take the lead in working with their hospitals' employee health departments to establish a PAPR training program where none exists. User instructions state that the PAPR should not be used during surgery because it generates positive outward airflow, and may increase the risk of wound infection. Clarification of this prohibition and acceptable solutions are currently lacking and need to be addressed. The surgical hood system is not an acceptable alternative. We provide on line a PAPR training workshop. Supporting information is presented here. Anesthesia and critical care providers may use this workshop to supplement, but not substitute for, the manufacturers' detailed use and maintenance instructions.
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Affiliation(s)
- Bonnie M Tompkins
- Department of Anesthesiology, University of Wisconsin Hospitals, Madison, WI 53792-0001, USA.
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Effect of surgical masks worn concurrently over N95 filtering facepiece respirators: extended service life versus increased user burden. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:E19-26. [PMID: 18287908 DOI: 10.1097/01.phh.0000311904.41691.fd] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Growing concern over the availability of Respiratory protective devices (eg, filtering facepiece Respirators), in the face of the probable extreme demand brought on by a pandemic influenza, has prompted the suggestion that useful life of N95 filtering facepiece Respirator can be extended by the concurrent use of a surgical mask as an outer protective barrier over the Respirator. Personal protective equipment generally places a strain on the user, and the detrimental physiological and psychological burdens normally imposed by Respirator use could be magnified by the addition of an extra layer of protection such as a surgical mask. The issue of this potentially increased burden of the concurrent use of a surgical facemask with an N95 filtering facepiece Respirator is investigated to afford users the necessary information to make informed decisions Regarding the use of this Respiratory personal protective equipment in the face of large-scale outbreaks of Respiratory pathogens.
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Abstract
PURPOSE OF REVIEW Pandemic influenza remains a threat to world health and will probably result in an overwhelming number of critically ill patients. Preparations should be made now to meet this threat. RECENT FINDINGS Limited data are available on which to base preparations. Adequate staffing is crucial to the functioning of an ICU and therefore occupational safety is of central concern. In the absence of knowledge of the method of spread of a pandemic disease, it would seem appropriate to take airborne and contact precautions, and the literature related to this area is reviewed. Methods of recruiting and training additional staff and the issues of bed capacity, stockpiling, triage and ethics are discussed. SUMMARY Extensive preparation is needed in advance of an epidemic. This should include occupational safety measures, stockpiling of equipment and drugs, staff training, development of triage policies, and discussion of the limits of duty of care to patients. These preparations take considerable time and therefore these issues should be tackled urgently.
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Gomersall CD, Tai DYH, Loo S, Derrick JL, Goh MS, Buckley TA, Chua C, Ho KM, Raghavan GP, Ho OM, Lee LB, Joynt GM. Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Med 2006; 32:1004-13. [PMID: 16570146 DOI: 10.1007/s00134-006-0134-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 02/22/2006] [Indexed: 11/24/2022]
Abstract
Epidemics have the potential to severely strain intensive care resources and may require an increase in intensive care capability. Few intensivists have direct experience of rapidly expanding intensive care services in response to an epidemic. This contribution presents the recommendations of an expert group from Hong Kong and Singapore who had direct experience of expanding intensive care services in response to the epidemic of severe acute respiratory syndrome. These recommendations cover training, infection control, staffing, communication and ethical issues. The issue of what equipment to purchase is not addressed. Early preparations should include fit testing of negative pressure respirators, training of reserve staff, sourcing of material for physical modifications to the ICU, development of infection control policies and training programmes, and discussion of triage and quarantine issues.
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Affiliation(s)
- Charles D Gomersall
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, China.
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Ahmed N, Hare GMT, Merkley J, Devlin R, Baker A. Open tracheostomy in a suspect severe acute respiratory syndrome (SARS) patient: brief technical communication. Can J Surg 2005; 48:68-71. [PMID: 15757043 PMCID: PMC3211558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Najma Ahmed
- Critical Care Department, St. Michael's Hospital, University of Toronto, Toronto, Ont.
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Tang J, Chan R. Severe acute respiratory syndrome (SARS) in intensive care units (ICUs): limiting the risk to healthcare workers. CURRENT ANAESTHESIA AND CRITICAL CARE 2004; 15:143-155. [PMID: 32288321 PMCID: PMC7135788 DOI: 10.1016/j.cacc.2004.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The global epidemic of severe acute respiratory syndrome (SARS) during the first half of 2003 resulted in over 8000 cases with more than 800 deaths. Many of those who eventually died, did so in the critical (intensive) care units of various hospitals around the world, and many secondary cases of SARS arose in healthcare workers looking after such patients in these units. Research on SARS coronavirus (SARS CoV) demonstrated that this virus belongs to the same family of viruses, the Coronaviridae that causes the common cold, with some important differences. Properties of this virus have been discovered which can be used to develop important infection control policies within hospitals to limit the number of secondary cases. These properties include environmental survival, transmissibility, viral load in various organs and fluids and periods of symptomatic illness during which infectivity is greatest. Various barrier methods were used throughout the epidemic to protect healthcare workers from SARS, with varying degrees of success. Treatment of SARS patients has mainly involved steroid therapy, with or without ribavirin, but there is no consensus on the best treatment protocol, as yet. This review focuses on the implications of SARS for healthcare workers and patients on critical care units.
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Affiliation(s)
- J.W. Tang
- Royal Free and University College Medical Schools, Centre for Virology, Division of Infection and Immunity, Windeyer Building, 46 Cleveland Street, London W1T 4JF, UK
| | - R.C.W. Chan
- Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administration Region (SAR), China
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