How to minimize airborne droplet contamination while performing laparoscopy in the COVID-19 era.
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ABSTRACT:
SUBMITTER: Birch B
PROVIDER: S-EPMC7675290 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment.
| S-EPMC8083507 | biostudies-literature
Project description:COVID-19 is a global pandemic with over 25 million cases worldwide. Currently, treatments are limited, and there is no approved vaccine. Interventions such as handwashing, masks, social distancing, and "social bubbles" are used to limit community transmission, but it is challenging to choose the best interventions for a given activity. Here, we provide a quantitative framework to determine which interventions are likely to have the most impact in which settings. We introduce the concept of "event R," the expected number of new infections due to the presence of a single infectious individual at an event. We obtain a fundamental relationship between event R and four parameters: transmission intensity, duration of exposure, the proximity of individuals, and the degree of mixing. We use reports of small outbreaks to establish event R and transmission intensity in a range of settings. We identify principles that guide whether physical distancing, masks and other barriers to transmission, or social bubbles will be most effective. We outline how this information can be obtained and used to reopen economies with principled measures to reduce COVID-19 transmission.
| S-EPMC7749284 | biostudies-literature
Project description:PurposeThe purpose of this study is to evaluate fluid droplet spray generation during phacoemulsification (PE), pars plana vitrectomy (PPV), and fragmatome lensectomy (FL) and assess factors affecting these.MethodsThis is an experimental study. PE through 2.2 and 2.8 mm incisions was performed in six goat eyes and four simulator eyes using both continuous and interrupted ultrasound (U/S). PPV and FL were performed in three goat eyes. Generation of visible fluid droplet spray was analyzed from video recordings through the microscope camera and an external digital camera. Hydroxypropylmethylcellulose (HPMC) was applied over the incision site during PE and FL.ResultsWhen PE was performed through both incision sizes, there was no visible fluid droplet spray if the phaco tip was centered in the incision, without sleeve compression. When there was phaco tip movement with the phaco sleeve sandwiched between the tip and the incision wall, there was visible fluid droplet spray generation. It was more difficult to induce fluid droplet spray with 2.8 mm incision, and spray was lesser with interrupted U/S. During PPV, there was no droplet spray. During FL, fluid droplet spray was only seen when U/S was delivered with the fragmatome tip close to the sclerotomy. HPMC impeded droplet spray.ConclusionFluid droplet generation during PE can be minimized to a large extent by keeping the phaco tip centered within the incision, avoiding sleeve compression. Smaller incision and continuous U/S were more prone to droplet generation. FL should be performed away from sclerotomy. HPMC over incision is recommended.
| S-EPMC7727940 | biostudies-literature
Project description:ObjectivePresent guidelines on reducing aerosol generation during neurosurgical procedures are futile. The aim of this article was to describe a novel device to contain aerosol within a small localized environment around the operative field-the negative pressure assisted microenvironment surgical hood (NEPA-MESH).MethodsThis device can be assembled using easily available materials-steel wires, image intensifier cover, surgical drape, and three-dimensional-printed self-locking copolyester double hoops. Large-bore pipes in continuity with a high-volume suction apparatus create a constant negative pressure microenvironment around the operative field. The CEM DT-9880 particle counter was used to estimate particle concentration inside the NEPA-MESH during various stages of a neurosurgical procedure as well as outside. The NEPA-MESH was tested in different craniotomies and endoscopic procedures.ResultsMean particle concentration inside the NEPA-MESH and outside during drilling in various procedures was calculated and compared using unpaired t test. Significant reduction in particle concentrations was recorded for particles sized 0.3 μm (t = 17.55, P < 0.0001), 0.5 μm (t = 11.39, P < 0.0001), 1 μm (t = 6.36, P = 0.0002), 2.5 μm (t = 2.04, P = 0.074), 5.0 μm (t = 7.026, P = 0.0008), and 10 μm (t = 4.39, P = 0.0023).ConclusionsAs definitive evidence demonstrating the presence of coronavirus disease 2019 (COVID-19) in aerosol particles is awaited, we describe a cost-effective strategy to reduce aerosol contamination. Significant reduction in particle concentrations was seen outside the NEPA-MESH compared with inside it during various stages of neurosurgical procedures.
| S-EPMC7972824 | biostudies-literature
Project description:BackgroundThe intubation of patients with coronavirus disease 2019 (COVID-19) puts health care workers at risk of infection through aerosol, droplet and contact contamination. We evaluated the risk of droplet and contact contamination for health care workers using 3 intubation barrier techniques as part of a quality assurance study at our institution.MethodsThis randomized quality assurance study was completed at a tertiary academic hospital in Vancouver, British Columbia, Canada, on Apr. 4, 2020. Participants in personal protective equipment performed simulated intubations on a manikin with (a) no barrier, (b) a clear plastic sheet covering the manikin and (c) a plexiglass intubation box over the manikin, in random order. Fluorescein was ejected from inside the manikin's mouth to simulate droplet and contact spread during a standard intubation sequence. Two blinded independent assessors evaluated the location and degree of contamination on the intubator and assistant using an ultraviolet light. Contamination severity was rated in a standard fashion (0 = none; 1 = minor; 2 = major). The primary outcome was total contamination score and secondary outcomes were scores between intubator and assistant, anatomic areas contaminated and qualitative feedback on ease of intubation.ResultsFive participants completed this study. Total contamination score was different between the 3 groups for the intubator (p = 0.02) but not the assistant (p = 0.2). For the intubator, the total contamination score was higher when the sheet was used (median 29 [interquartile range (IQR) 25-34]) than when the box was used (median 17 [IQR 15-22]) or when no barrier was used (median 18 [IQR 13-21]). All 5 participants reported challenges during intubation using the sheet.InterpretationUse of a plastic sheet while intubating patients with COVID-19 may increase the risk of droplet and contact contamination during intubation and impede intubation. Further study should be undertaken before implementing barrier techniques in practice.
| S-EPMC7641175 | biostudies-literature
Project description:BackgroundWe present a novel approach for exiting coronavirus disease 2019 (COVID-19) lockdowns using a 'risk scorecard' to prioritize activities to resume whilst allowing safe reopening.MethodsWe modelled cases generated in the community/week, incorporating parameters for social distancing, contact tracing and imported cases. We set thresholds for cases and analysed the effect of varying parameters. An online tool to facilitate country-specific use including the modification of parameters (https://sshsphdemos.shinyapps.io/covid_riskbudget/) enables visualization of effects of parameter changes and trade-offs. Local outbreak investigation data from Singapore illustrate this.ResultsSetting a threshold of 0.9 mean number of secondary cases arising from a case to keep R < 1, we showed that opening all activities excluding high-risk ones (e.g. nightclubs) allows cases to remain within threshold; while opening high-risk activities would exceed the threshold and result in escalating cases. An 80% reduction in imported cases per week (141 to 29) reduced steady-state cases by 30% (295 to 205). One-off surges in cases (due to superspreading) had no effect on the steady state if the R remains <1. Increasing the effectiveness of contact tracing (probability of a community case being isolated when infectious) by 33% (0.6 to 0.8) reduced cases by 22% (295 to 231). Cases grew exponentially if the product of the mean number of secondary cases arising from a case and (1-probability of case being isolated) was >1.ConclusionsCountries can utilize a 'risk scorecard' to balance relaxations for travel and domestic activity depending on factors that reduce disease impact, including hospital/ICU capacity, contact tracing, quarantine and vaccination. The tool enabled visualization of the combinations of imported cases and activity levels on the case numbers and the trade-offs required. For vaccination, a reduction factor should be applied both for likelihood of an infected case being present and a close contact getting infected.
| S-EPMC8420627 | biostudies-literature
Project description:Abstract:We review the state of knowledge on the bio-fluid dynamic mechanisms involved in the transmission of the infection from SARS-CoV-2. The relevance of the subject stems from the key role of airborne virus transmission by viral particles released by an infected person via coughing, sneezing, speaking or simply breathing. Speech droplets generated by asymptomatic disease carriers are also considered for their viral load and potential for infection. Proper understanding of the mechanics of the complex processes whereby the two-phase flow emitted by an infected individual disperses into the environment would allow us to infer from first principles the practical rules to be imposed on social distancing and on the use of facial and eye protection, which to date have been adopted on a rather empirical basis. These measures need compelling scientific validation. A deeper understanding of the relevant biological fluid dynamics would also allow us to evaluate the contrasting effects of natural or forced ventilation of environments on the transmission of contagion: the risk decreases as the viral load is diluted by mixing effects but contagion is potentially allowed to reach larger distances from the infected source. To that end, our survey supports the view that a formal assessment of a number of open problems is needed. They are outlined in the discussion. Graphic abstract:
| S-EPMC7429142 | biostudies-literature
Project description:BackgroundThe Covid-19 pandemic has had a profound impact on the Otolaryngology outpatient clinical practice, which is at high risk of respiratory viral transmission due to the close contact between the examiner and the patient's airway secretions [1]. Moreover, most otolaryngological procedures, including oropharyngoscopy, generate droplets or aerosols from high viral shedding areas [1]. Thus, only non-deferrable consultations were performed in the outbreak's acute phase. Along with the re-opening of elective clinical services and the impending second wave of the outbreak, a reorganization is necessary to minimize the risk of nosocomial transmission [1].MethodsThis video (Video 1) shows how to safely conduct an outpatient Otorhinolaryngological consultation, focusing on complete ear, nose and throat examination, according to evidences from the published literature and Otolaryngological societies guidelines [2,3].ResultsAfter telephonic screening, patients reporting Covid-19 symptoms or closecontact with a Covid-19 case within the last 14 days are referred to telehealth services [1-3]. To avoid crowding, the patient is admitted alone, after body temperature control, except for underage or disabled people [1]. The waiting room assessment must guarantee a social distance of 6 ft [1-3]. The consultation room is reorganized into two separate areas (Fig. 1): 1) a clean desk area, where an assistant wearing a surgical mask and gloves, handles the patient's documentation and writes the medical report, keeping proper distance from the patient, and 2) a separate consultation area, where the examiner, equipped with proper personal protective equipment (Fig. 2) [3,4], carries out the medical interview and physical examination. Endoscopic-assisted ear, nose and throat inspection using a dedicated monitor allows the examiner to maintain an adequate distance from the patient throughout the procedure while providing an optimal view (Figs. 3-6) [3]. Recent evidence shows that nasal endoscopy does not increase droplet production compared to traditional otolaryngological examination [5]. When necessary, nasal topic decongestion and anesthesia must be performed using cottonoids rather than sprays [3]. The patient keeps the nose and mouth covered throughout the consultation, lowering the surgical mask on the mouth for nasal endoscopy and removing it only for oropharyngoscopy. After the consultation, the doffing procedure must be carried out carefully to avoid contamination [4]. All the equipment and surfaces must undergo high-level disinfection with 70% alcohol or 0.1% bleach solutions [3]. Proper room ventilation must precede the next consultation [3].ConclusionsThe hints provided in this video are useful to ensure both patient and examiner safety during Otolaryngological outpatient consultations and to reduce SARS-CoV-2 transmission.
| S-EPMC7781528 | biostudies-literature
Project description:OBJECTIVES:There are no societal ultrasound guidelines detailing appropriate patient selection for deep vein thrombosis (DVT) imaging in COVID-19 patients nor are there protocol recommendations aimed at decreasing exposure time for ultrasound technologists. We aimed to provide COVID-19 specific protocol optimization recommendations limiting ultrasound technologist exposure while optimizing patient selection. METHODS:A novel two-pronged algorithm was implemented to limit the DVT ultrasound studies on COVID-19 patients prospectively which included direct physician communication with the care team and a COVID-19 specific imaging protocol was instated to reduce ultrasound technologist exposure. In order to assess pretest risk of DVT, sensitivity and specificity of serum D-Dimer in 500-unit increments from 500 to 8000 ng/mL and a receiver operating characteristic curve (ROC) to assess performance of serum D-Dimer in predicting DVT was generated. Rates of DVT, pulmonary embolism (PE) and scan times were compared using t-test and Fisher's exact test (before and after implementation of the protocol). RESULTS:Direct physician communication resulted in cancellation or deferral of 72% of requested exams in COVID-19 positive patients. A serum D-Dimer > 4000ng/mL yielded a sensitivity of 80% and a specificity of 70% (CI: 0.54-0.86) for venous thromboembolism. Using the COVID-19 specific protocol, there was a significant (50%) reduction in scan time (p<0.0001) in comparison with conventional protocol. CONCLUSION:A direct physician communication policy between imaging physician and referring physician resulted in deferral or cancellation of a majority of requested DVT ultrasound exams. An abbreviated COVID-19 specific imaging protocol significantly decreased exposure time to the ultrasound technologist.
| S-EPMC7418643 | biostudies-literature
Project description: Not available
| S-BSST563 | biostudies-other