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"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.

ABSTRACT: OBJECTIVE:Given high COVID-19 viral load and aerosolization in the head and neck, otolaryngologists are subject to uniquely elevated viral exposure in most of their inpatient and outpatient procedures and interventions. While elective activity has halted across the board nationally, the slow plateau of COVID-19 case rates prompts the question of timing of resumption of clinical activity. We sought to prospectively predict geographical "hot zones" for otolaryngological exposure to COVID-19 based on procedural volumes data from 2013 to 2017. METHODS:Otolaryngologic CPT codes were stratified based on risk-level, according to recently published specialty-specific guidelines. Using the Medicare POSPUF database, aerosol-generating procedures (AGPs) were mapped based on hospital referral regions, against up-to-date COVID-19 case distribution data, as of April 24, 2020. RESULTS:The most common AGPs were diagnostic flexible laryngoscopy, diagnostic nasal endoscopy, and flexible laryngoscopy with stroboscopy. The regions with the most AGPs per otolaryngologist were Iowa City, IA, Detroit, MI, and Burlington, VT, while the states with the most COVID-19 cases as of April 24th are New York, New Jersey, and Massachusetts. CONCLUSIONS:Our study provides a model for predicting possible "hot zones" for otolaryngologic exposure based on both COVID-19 case density and AGP-density. As the focus shifts to resuming elective procedures, these potential "hot zones" need to be evaluated for appropriate risk-based decision-making, such as "reopening strategies" and allocation of resources.

SUBMITTER: Quereshy HA

PROVIDER: S-EPMC7251363 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.

Quereshy Humzah A HA Jella Tarun K TK Ruthberg Jeremy S JS Kocharyan Armine A D'Anza Brian B Maronian Nicole N Otteson Todd D TD

American journal of otolaryngology 20200527 4

<h4>Objective</h4>Given high COVID-19 viral load and aerosolization in the head and neck, otolaryngologists are subject to uniquely elevated viral exposure in most of their inpatient and outpatient procedures and interventions. While elective activity has halted across the board nationally, the slow plateau of COVID-19 case rates prompts the question of timing of resumption of clinical activity. We sought to prospectively predict geographical "hot zones" for otolaryngological exposure to COVID-1 ...[more]

PMID: 32485299

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Project description:ObjectivesThis study evaluated particle spread associated with various common periodontal aerosol-generating procedures (AGPs) in simulated and clinical settings.Materials and methodsA simulation study visualized the aerosols, droplets, and splatter spread with and without high-volume suction (HVS, 325 L/min) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis, and implant drilling after fluorescein dye was added to the water irrigant as a tracer. Each procedure was repeated 10 times. A complementary clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 min of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment.ResultsThe simulation study data showed that air flow produced the highest amount of splatters and the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. The use of HVS effectively reduced 37.5-96% of splatter generation for all three dental AGPs, as well as 82-93% of aerosol and droplet particles at 1.2 m for the ultrasonic scaler and air polisher. In the clinical study, higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread.ConclusionsWhile three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout the 10-min dental operatory.Clinical relevanceThe likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, suggesting that the the majority of the contamination consisits of the irrigant rather than organic matter from the oral cavity.

Project description:BackgroundDuring medical procedures with the potential to produce aerosols such as bronchoscopy, intubation, or CPR, health-care workers (HCWs) may be exposed to infectious bioaerosols. This scenario is of particular concern when high consequence pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are circulating. Thousands of HCWs have been infected with SARS-CoV-2. However, the determinants of aerosol generation during medical procedures and their relative risk to HCWs remain poorly characterized.Research questionThe goal of this study was to characterize aerosols produced during airway intubation by using an uninfected translational animal model and in human subjects undergoing elective aerosol-generating procedures. The study also determined the particle size distribution of generated particles.Study design and methodsAerosol generation was measured during highly controlled experimental (pig) intubations (N = 16) and elective bronchoscopies in uninfected patients (N = 49) using an optical particle counter. Recovery of normal respiratory flora was used as a surrogate for pathogen dispersion.ResultsThere was a small but significant (P = .03) decrease in 0.3 μm size particles during highly controlled pig intubations compared with baseline. The concentration of 1.0 μm and 5.0 μm aerosol particles did not significantly change, although oral bacteria were collected from the air. For elective patient bronchoscopies, there was a significant decrease in the generation of larger particles (1.0 μm and 5.0 μm) compared with baseline (P < .01); however, 18 of 39 (46%) patients showed increased aerosol production in 0.3 μm size particles, four of whom exhibited measurable increases.InterpretationAlthough the total amount of aerosols produced during intubation and bronchoscopy did not increase significantly relative to preprocedural levels, a small number of participants exhibited a measurable increase in submicron particle emission, meriting further research to delineate determinants of fine particle production during aerosol-generating procedures.

Project description:INTRODUCTION:Coronavirus disease 2019 (COVID-19) is a contagious disease that is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Health care workers are at risk of infection from aerosolisation of respiratory secretions, droplet and contact spread. There are a number of procedures that represent a high risk of aerosol generation during cardiothoracic surgery. It is important that adequate training, equipment and procedures are in place to reduce that risk. RECOMMENDATIONS:We provide a number of key recommendations, which reduce the risk of aerosol generation during cardiothoracic surgery and help protect patients and staff. These include general measures such as patient risk stratification, appropriate use of personal protective equipment, consideration to delay surgery in positive patients, and careful attention to theatre planning and preparation. There are also recommended procedural interventions during airway management, transoesophageal echocardiography, cardiopulmonary bypass, chest drain management and specific cardiothoracic surgical procedures. Controversies exist regarding the management of low risk patients undergoing procedures at high risk of aerosol generation, and recommendations for these patients will change depending on the regional prevalence, risk of community transmission and the potential for asymptomatic patients attending for these procedures. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT:This statement reflects changes in management based on expert opinion, national guidelines and available evidence. Our knowledge with regard to COVID-19 continues to evolve and with this, guidance may change and develop. Our colleagues are urged to follow national guidelines and institutional recommendations regarding best practices to protect their patients and themselves. ENDORSED BY:Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Anaesthetic Continuing Education Cardiac Thoracic Vascular and Perfusion Special Interest Group.

Dataset Information

"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.

Publications

"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.

Similar Datasets

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