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1.
Ann Surg ; 272(2): e125-e128, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675514

RESUMO

BACKGROUND: In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context. METHODS: A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada. RESULTS: The working group divided the risk for aerosol into 6 time-points: (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point. CONCLUSIONS: The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/epidemiologia , Contaminação de Equipamentos/prevenção & controle , Controle de Infecções/normas , Neoplasias Pulmonares/cirurgia , Salas Cirúrgicas , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Pulmonares/normas , Betacoronavirus , Procedimentos Cirúrgicos Eletivos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Equipamento de Proteção Individual , Quebeque/epidemiologia
2.
Rev Col Bras Cir ; 47: e20202574, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32578696

RESUMO

The COVID-19 Pandemic has resulted in a high number of hospital admissions and some of those patients need ventilatory support in intensive care units. The viral pneumonia secondary to Sars-cov-2 infection may lead to acute respiratory distress syndrome (ARDS) and longer mechanical ventilation needs, resulting in a higher demand for tracheostomies. Due to the high aerosolization potential of such procedure, and the associated risks of staff and envoirenment contamination, it is necesseray to develop a specific standardization of the of the whole process involving tracheostomies. This manuscript aims to demonstrate the main steps of the standardization created by a tracheostomy team in a tertiary hospital dedicated to providing care for patients with COVID-19.


Assuntos
Infecções por Coronavirus/cirurgia , Procedimentos Cirúrgicos Eletivos/normas , Pneumonia Viral/cirurgia , Centros de Atenção Terciária/normas , Traqueostomia/normas , Aerossóis/efeitos adversos , Betacoronavirus , Brasil , Infecções por Coronavirus/prevenção & controle , Humanos , Salas Cirúrgicas/normas , Duração da Cirurgia , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle
3.
Rev Col Bras Cir ; 47: e20202558, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578821

RESUMO

The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Laparoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Período Intraoperatório , Salas Cirúrgicas/métodos , Pneumoperitônio Artificial/normas , Equipamentos de Proteção/normas , Punções/métodos , Instrumentos Cirúrgicos/normas
4.
Rev Esp Salud Publica ; 942020 Jun 03.
Artigo em Espanhol | MEDLINE | ID: mdl-32487985

RESUMO

The pandemic declared by SARS-CoV-2 has meant a crisis in the health system that forced the urgent implementation of preventive public health measures. The respiratory transmission virus remains stable on surfaces, being able to spread by air in respiratory droplets or in procedures that generate aerosols. Dental activity is one of the professional sectors with the highest exposure index, both due to the generation of aerosols in most interventions, as well as the impossibility of maintaining a safe distance between patients and professionals. The postponement of scheduled and non-urgent healthcare activities in dental offices is one of the measures implemented to reduce the risk that it posed for the health and well-being of citizens. This report addresses the recommendations and measures to be taken into account to minimize risks in the Oral Health Units of the Andalusian Public Health System, to address the oral pathology of the population assigned in the scenario of improvement of the pandemic and its partial lack of confinement.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência Odontológica , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/transmissão , Espanha/epidemiologia
5.
J Otolaryngol Head Neck Surg ; 49(1): 36, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493489

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for Coronavirus disease 2019 (COVID-19) has a predilection for infecting the mucosa of the upper and lower airways. Otolaryngologists and supporting health care workers (HCWs) are particularly at high risk of becoming infected while treating patients as many in-office procedures and surgeries are Aerosol Generating Medical Procedures (AGMP). Based on a review of the literature and various guidelines, recommendations are made to mitigate the risk to health care workers of becoming infected with SARS-CoV-2 while providing clinical care. RECOMMENDATIONS: During the COVID-19 pandemic all elective and non-time sensitive Otolaryngology procedures should be deferred to mitigate the risk of transmission of infection to HCWs. For non-AGMPs in all patients, even COVID-19 positive patients Level 1 PPE (surgical mask, gown, gloves and face shield or goggles) is sufficient. If local prevalence is favourable and patients are asymptomatic and test negative for SARS-CoV-2, Level 1 PPE can be used during short duration AGMPs, with limited risk of infected aerosol spread. For AGMPs in patients who test positive for SARS-CoV-2 a minimum of Level 2 PPE, with adequate protection of mucosal surfaces, is recommended (N95/FFP2 respirator, gown, double gloves, goggles or face shield and head cover). For long duration AGMPs that are deemed high-risk in COVID-19 positive patients, Level 3 PPE can provide a higher level of protection and be more comfortable during long duration surgeries if surgical hoods or PAPRs are used. It is recommended that these procedures are performed in negative pressure rooms, if available. It is essential to follow strict donning and doffing protocols to minimize the risk of contamination. CONCLUSIONS: By following strict infection prevention recommendations, the risk of HCWs becoming infected with SARS-CoV-2 while treating patients can be minimized. As the COVID-19 pandemic evolves rapidly, these recommendations should serve as guidance and need to be interpreted based on local factors and availability of healthcare resources.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otolaringologia/normas , Otorrinolaringopatias/terapia , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/normas , Humanos , Otolaringologia/organização & administração , Otorrinolaringopatias/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Equipamentos de Proteção/normas
7.
Otolaryngol Head Neck Surg ; 163(1): 107-109, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423299

RESUMO

Diagnostic flexible laryngoscopy (DFL) is a critical tool in the armamentarium of an otolaryngologist. However, in the midst of the COVID-19 pandemic, DFL represents a high-risk procedure for patients and otolaryngologists due to the risk of aerosolization. In cases where DFL is required, in patients with COVID-19 positivity or unknown COVID-19 status, we describe the use of a modified endoscopy face mask as an adjunct to personal protection equipment to reduce occupational transmission of COVID-19 while performing DFL. Our modified endoscopy mask provides an additional barrier against the transmission of airborne pathogens. The modified endoscopy face mask may also serve as a useful tool for otolaryngologists as they return to performing more aerosol-generating procedures in the outpatient setting.


Assuntos
Aerossóis/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Laringoscopia/normas , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Humanos , Manequins , Pneumonia Viral/transmissão
8.
Otolaryngol Head Neck Surg ; 163(1): 151-155, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423338

RESUMO

OBJECTIVES: This study aimed to identify escape of small-particle aerosols from a variety of masks using simulated breathing conditions. This study also aimed to evaluate the efficacy of a negative-pressure environment around the face in preventing the escape of small aerosolized particles. STUDY DESIGN: This study is an evaluation study with specific methodology described below. SETTING: This study was performed in our institution's fresh tissue laboratory. SUBJECTS AND METHODS: A fixed cadaver head was placed in a controlled environment with a black background, and small-particle aerosols were created using joss incense sticks (mass-median aerosol diameter of 0.28 µ). Smoke was passed through the cadaver head, and images were taken with a high-resolution camera in a standardized manner. Digital image processing was used to calculate relative amounts of small-particle escape from a variety of masks, including a standard surgical mask, a modified Ambu mask, and our negative airway pressure respirator (NAPR). RESULTS: Significant amounts of aerosolized particles escaped during the trials with no mask, a standard surgical mask, and the NAPR without suction. When suction was applied to the NAPR, creating a negative-pressure system, no particle escape was noted. CONCLUSION: We present a new and effective method for the study of small-particle aerosols as a step toward better understanding the spread of these particles and the transmission of coronavirus disease 2019. We also present the concept of an NAPR to better protect health care workers from aerosols generated from the upper and lower airways.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Máscaras/normas , Pneumonia Viral/epidemiologia , Respiradores de Pressão Negativa/normas , Betacoronavirus , Cadáver , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Humanos , Pandemias , Tamanho da Partícula , Pneumonia Viral/transmissão , Reprodutibilidade dos Testes
9.
Bull Environ Contam Toxicol ; 104(6): 724-726, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32394052

RESUMO

Corona virus diseases-2019 (COVID-19), an infectious disease identified in late December, 2019, in Wuhan city of China, was declared a pandemic by the World Health Organization. Most countries including India have announced some sort of lockdown to reduce the effects of COVID-19 and discontinue the transmission of novel coronavirus. Major negative effects on the social and surrounding environment have been reported due to COVID-19, however positive effects have also been observed with respect to air quality. Secondary results have been taken from National Aeronautics and Space Administration (NASA), indicating significant reduction (50%) in air quality of Indian region. This perspective highlights the effects of the lockdown due to COVID-19 on aerosol optical thickness specifically in India.


Assuntos
Poluição do Ar/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Aerossóis/efeitos adversos , Poluição do Ar/efeitos adversos , Poluição do Ar/prevenção & controle , Humanos , Índia/epidemiologia
10.
Ann R Coll Surg Engl ; 102(5): 323-332, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32352836

RESUMO

INTRODUCTION: Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS: A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS: Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS: During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.


Assuntos
Abdome Agudo/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Salas Cirúrgicas/organização & administração , Pandemias , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Abdome Agudo/complicações , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/métodos , Laparoscopia/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumoperitônio Artificial/efeitos adversos , Prática Profissional/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos
11.
Prehosp Disaster Med ; 35(4): 434-437, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32398188

RESUMO

The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos Descartáveis , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Aerossóis/efeitos adversos , Betacoronavirus , Líquidos Corporais/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Equipamentos Descartáveis/economia , Desenho de Equipamento , Humanos , Equipamento de Proteção Individual/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Taiwan/epidemiologia
12.
J Otolaryngol Head Neck Surg ; 49(1): 28, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375884

RESUMO

BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Humanos , Otorrinolaringopatias/complicações , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/virologia , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto
13.
J Otolaryngol Head Neck Surg ; 49(1): 29, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393346

RESUMO

BACKGROUND: Adequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified. MAIN BODY: Health care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75-7.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission. CONCLUSION: Direct and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Equipamento de Proteção Individual/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Sistema Respiratório/virologia , Carga Viral
14.
Indian J Ophthalmol ; 68(6): 981-983, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32461409

RESUMO

Since the onset of the COVID-19 pandemic, there has been an advisory for regular and thorough cleaning of hands besides other measures such as social distancing and self-isolation. The rationale for the same is to prevent the transfer of the virus from hands that have come in contact with fomites. While both alcohol-based hand rubs (ABHR) or washing with soap and water are claimed to have been effective, hand sanitizers have gained more popularity due to the ease of use. The increased frequency of ABHR use and the aerosols generated pose a potential threat to the skin and exposed mucosal surfaces, especially that of the eye due to the proximity of use. The adverse effects of alcohol in these sanitizers can be manifold. An allergic or inflammatory response can occur depending on the predisposing or preexisting conditions. This article describes the risks, underlying mechanisms, and preventive measures for sanitizer aerosol-driven ocular surface disease.


Assuntos
Aerossóis/efeitos adversos , Betacoronavirus , Conjuntivite Alérgica/induzido quimicamente , Infecções por Coronavirus/epidemiologia , Higienizadores de Mão/efeitos adversos , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Conjuntivite Alérgica/diagnóstico , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Telemedicina
15.
Surg Infect (Larchmt) ; 21(4): 301-308, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32310715

RESUMO

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos/normas , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Adulto , Aerossóis/efeitos adversos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Instalações de Saúde/normas , Humanos , Controle de Infecções/métodos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/normas , Intubação Intratraqueal/efeitos adversos , Segurança do Paciente/normas , Assistência Perioperatória/métodos , Pneumonia Viral/complicações
17.
Surg Endosc ; 34(6): 2327-2331, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32323016

RESUMO

The unprecedented pandemic of COVID-19 has impacted many lives and affects the whole healthcare systems globally. In addition to the considerable workload challenges, surgeons are faced with a number of uncertainties regarding their own safety, practice, and overall patient care. This guide has been drafted at short notice to advise on specific issues related to surgical service provision and the safety of minimally invasive surgery during the COVID-19 pandemic. Although laparoscopy can theoretically lead to aerosolization of blood borne viruses, there is no evidence available to confirm this is the case with COVID-19. The ultimate decision on the approach should be made after considering the proven benefits of laparoscopic techniques versus the potential theoretical risks of aerosolization. Nevertheless, erring on the side of safety would warrant treating the coronavirus as exhibiting similar aerosolization properties and all members of the OR staff should use personal protective equipment (PPE) in all surgical procedures during the pandemic regardless of known or suspected COVID status. Pneumoperitoneum should be safely evacuated via a filtration system before closure, trocar removal, specimen extraction, or conversion to open. All emergent endoscopic procedures performed during the pandemic should be considered as high risk and PPE must be used by all endoscopy staff.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia/normas , Controle de Infecções/normas , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Endoscopia/efeitos adversos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
18.
Semin Cardiothorac Vasc Anesth ; 24(2): 127-137, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32336243

RESUMO

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, Hubei, China, and has spread to more than 200 other countries around the world. COVID-19 is a highly contagious disease with continuous human-to-human transmission. The origin of the virus is unknown. Airway manipulations and intubations, which are common during anesthesia procedures may increasingly expose anesthesia providers and intensive care unit team members to SARS-CoV-2. Through a comprehensive review of existing studies on COVID-19, this article presents the epidemiological and clinical characteristics of COVID-19, reviews current medical management, and suggests ways to improve the safety of anesthetic procedures. Owing to the highly contagious nature of the virus and the lack of therapeutic drugs or vaccines, precautions should be taken to prevent medical staff from COVID-19.


Assuntos
Anestesia/normas , Anestesiologia/normas , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Anestesia/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Risco
19.
J Gastroenterol Hepatol ; 35(5): 749-759, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233034

RESUMO

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.


Assuntos
Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia Gastrointestinal/normas , Unidades Hospitalares/normas , Controle de Infecções/normas , Pandemias , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Endoscopia/normas , Unidades Hospitalares/organização & administração , Humanos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto
20.
J Laparoendosc Adv Surg Tech A ; 30(5): 477-480, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32311303

RESUMO

Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/cirurgia , Traqueotomia/métodos , Aerossóis/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Carcinoma de Células Escamosas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Glote , Humanos , Controle de Infecções/normas , Neoplasias Laríngeas/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Insuficiência Respiratória/etiologia , Traqueotomia/efeitos adversos , Vigília
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