Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID-19 pandemic
Tóm tắt
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.
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.
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.
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.
Từ khóa
Tài liệu tham khảo
World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). Published 2020. Accessed April 16, 2020.
Mark A, Hall DO. Mary Anne Bobinski, Nicholas Bagley, I. Glenn Cohen. Health Care Law and Ethics. 9th ed. New York: Wolters Kluwer; 2018.
World Health Organization. Advice on the use of masks in the context of COVID-19. Interim guidance 6 April 2020. 2020;WHO/2019-nCov/IPC_Masks/2020.3.
Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020. [Epub ahead of print].
Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–1567.
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020. [Epub ahead of print].
Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19(1):101.
Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med. 2015;57(5):501–8.
Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–9.
American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists and the COVID-19 Pandemic. https://www.entnet.org/content/otolaryngologists-and-covid-19-pandemic. Published 2020. Accessed April 16, 2020.
Rudmik L, Smith TL. Development of an evidence-based review with recommendations using an online iterative process. Int Forum Allergy Rhinol. 2011;1(6):431–7.
Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE Handbook. https://gdt.gradepro.org/app/handbook/handbook.html. Published 2013. Accessed March, 15, 2019.
Workman AD, Welling DB, Carter BS, et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol. 2020. [Epub ahead of print].
Baig S, Rashid T, Saleem M. Protection from blood aerosol contamination when managing epistaxis: a study of the effectiveness of a patient mouth mask. Ear Nose Throat J. 2015;94(9):394–8.
Hassan MS, Trotter MI. Protection from epistaxis blood aerosol contamination: a novel use of a surgical facemask. Eur Arch Otorhinolaryngol. 2003;260(5):242–3.
Wallace HC, Harries PG. Epistaxis and conjunctival contamination--are our ENT trainees at risk? Ann R Coll Surg Engl. 2002;84(5):302–3.
Gralton J, Tovey E, McLaws ML, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: a review. J Inf Secur. 2011;62(1):1–13.
Genangeli M, Heeren RMA, Porta ST. Tissue classification by rapid evaporative ionization mass spectrometry (REIMS): comparison between a diathermic knife and CO. Anal Bioanal Chem. 2019;411(30):7943–55.
Kashima HK, Kessis T, Mounts P, Shah K. Polymerase chain reaction identification of human papillomavirus DNA in CO2 laser plume from recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg. 1991;104(2):191–5.
Garden JM, O'Banion MK, Shelnitz LS, et al. Papillomavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA. 1988;259(8):1199–202.
Sawchuk WS, Weber PJ, Lowy DR, Dzubow LM. Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol. 1989;21(1):41–9.
Gloster HM, Roenigk RK. Risk of acquiring human papillomavirus from the plume produced by the carbon dioxide laser in the treatment of warts. J Am Acad Dermatol. 1995;32(3):436–41.
Carr MM, Patel VA, Soo JC, Friend S, Lee EG. Effect of Electrocautery settings on particulate concentrations in surgical plume during tonsillectomy. Otolaryngol Head Neck Surg. 2020. [Epub ahead of print].
Subbarayan RS, Shew M, Enders J, Bur AM, Thomas SM. Occupational exposure of oropharyngeal human papillomavirus amongst otolaryngologists. Laryngoscope. 2019. [Epub ahead of print].
Brüske-Hohlfeld I, Preissler G, Jauch KW, et al. Surgical smoke and ultrafine particles. J Occup Med Toxicol. 2008;3:31.
Ishihama K, Sumioka S, Sakurada K, Kogo M. Floating aerial blood mists in the operating room. J Hazard Mater. 2010;181(1–3):1179–81.
Johnson GK, Robinson WS. Human immunodeficiency virus-1 (HIV-1) in the vapors of surgical power instruments. J Med Virol. 1991;33(1):47–50.
Chen WQ, Ling WH, Lu CY, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health. 2009;9:81.
Wei WI, Tuen HH, Ng RW, Lam LK. Safe tracheostomy for patients with severe acute respiratory syndrome. Laryngoscope. 2003;113(10):1777–9.
Chee VW, Khoo ML, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology. 2004;100(6):1394–8.
Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS). Can J Surg. 2005;48(1):71–4.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.
Raboud J, Shigayeva A, McGeer A, et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS ONE. 2010;5(5):e10717.
Ofner M, Lem M, Sarwal S, Vearncombe M, Simor A. Cluster of severe acute respiratory syndrome cases among protected health care workers-Toronto, April 2003. Can Commun Dis Rep. 2003;29(11):93–7.
He C, Mackay IM, Ramsay K, et al. Particle and bioaerosol characteristics in a paediatric intensive care unit. Environ Int. 2017;107:89–99.
Chung FF, Lin HL, Liu HE, et al. Aerosol distribution during open suctioning and long-term surveillance of air quality in a respiratory care center within a medical center. Respir Care. 2015;60(1):30–7.
Thompson KA, Pappachan JV, Bennett AM, et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic--the risk of aerosol generation during medical procedures. PLoS One. 2013;8(2):e56278.
Mousa M, Schwartz D, Carmeli Y, Nutman A. Droplet aerosol dissemination of carbapenem-resistant Acinetobacter baumannii surrounding ventilated patients. Infect Control Hosp Epidemiol. 2019;40(3):365–7.
Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiol Infect. 2004;132(5):797–803.
Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. eEmerg Infect Dis. 2004;10(2):251–5.
Ishihama K, Koizumi H, Wada T, et al. Evidence of aerosolised floating blood mist during oral surgery. J Hosp Infect. 2009;71(4):359–64.
Ishihama K, Iida S, Koizumi H, et al. High incidence of blood exposure due to imperceptible contaminated splatters during oral surgery. J Oral Maxillofac Surg. 2008;66(4):704–10.
Al-Eid RA, Ramalingam S, Sundar C, Aldawsari M, Nooh N. Detection of visually imperceptible blood contamination in the Oral surgical clinic using forensic Luminol blood detection agent. J Int Soc Prev Community Dent. 2018;8(4):327–32.
Hallier C, Williams DW, Potts AJ, Lewis MA. A pilot study of bioaerosol reduction using an air cleaning system during dental procedures. Br Dent J. 2010;209(8):E14.
Perdelli F1, Spagnolo AM, Cristina ML, et al. Evaluation of contamination by blood aerosols produced during various healthcare procedures. J Hosp Infect. 2008;70(2):174–9.
Buzatto GP, Tamashiro E, Proenca-Modena JL, et al. The pathogens profile in children with otitis media with effusion and adenoid hypertrophy. PLoS One. 2017;12(2):e0171049.
Alper CM, Winther B, Mandel EM, Hendley JO, Doyle WJ. Rate of concurrent otitis Media in Upper Respiratory Tract Infections with Specific Viruses. Arch Otolaryngol Head Neck Surg. 2009;135(1):17.
Norris BK, Goodier AP, Eby TL. Assessment of air quality during mastoidectomy. Otolaryngol Head Neck Surg. 2011;144(3):408–11.
Hilal A, Walshe P, Gendy S, Knowles S, Burns H. Mastoidectomy and trans-corneal viral transmission. Laryngoscope. 2005;115(10):1873–6.
Lannigan FJ, Jones NS, von Schoenberg MV. An avoidable occupational hazard during mastoid surgery. J Laryngol Otol. 1989;103(6):566.
Tseng TM, Chen PY, Tseng H, Lin HC, Chang CY, Hung SH. An unexpected route for otolaryngology bacterial contamination with a Venturi atomizer. Rhinology. 2014;52(2):156–61.
Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology. 2020. [Epub ahead of print].
Chang L, Zhao L, Gong H, Wang L. Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations. Emerg Infect Dis. 2020;26(7). [Epub ahead of print].
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
Chin AWH, Chu JTS, Perera MRA, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe. 2020;S2666-5247(20)30003–3.
Givi B, Schiff BA, Chinn SB, et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg. 2020. [Epub ahead of print].