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Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic.
J Otolaryngol Head Neck Surg. 2020 Jun 03; 49(1):36.JO

Abstract

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.

Authors+Show Affiliations

BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. JLea@providencehealth.bc.ca. Division of Otolaryngology-Head and Neck Surgery, BC Rotary Hearing and Balance Centre, St. Paul's Hospital, 1081 Burrard St, Vancouver, B.C, V6Z 1Y6, Canada. JLea@providencehealth.bc.ca.BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32493489

Citation

Lammers, Marc J W., et al. "Guidance for Otolaryngology Health Care Workers Performing Aerosol Generating Medical Procedures During the COVID-19 Pandemic." Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale, vol. 49, no. 1, 2020, p. 36.
Lammers MJW, Lea J, Westerberg BD. Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020;49(1):36.
Lammers, M. J. W., Lea, J., & Westerberg, B. D. (2020). Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic. Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale, 49(1), 36. https://doi.org/10.1186/s40463-020-00429-2
Lammers MJW, Lea J, Westerberg BD. Guidance for Otolaryngology Health Care Workers Performing Aerosol Generating Medical Procedures During the COVID-19 Pandemic. J Otolaryngol Head Neck Surg. 2020 Jun 3;49(1):36. PubMed PMID: 32493489.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic. AU - Lammers,Marc J W, AU - Lea,Jane, AU - Westerberg,Brian D, Y1 - 2020/06/03/ PY - 2020/04/16/received PY - 2020/05/20/accepted PY - 2020/6/5/entrez PY - 2020/6/5/pubmed PY - 2020/6/9/medline KW - Aerosol KW - COVID-19 KW - Guideline KW - PAPR KW - PPE KW - Pandemic KW - Respirator KW - Review SP - 36 EP - 36 JF - Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale JO - J Otolaryngol Head Neck Surg VL - 49 IS - 1 N2 - 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. SN - 1916-0216 UR - https://www.unboundmedicine.com/medline/citation/32493489/Guidance_for_otolaryngology_health_care_workers_performing_aerosol_generating_medical_procedures_during_the_COVID_19_pandemic_ L2 - https://journalotohns.biomedcentral.com/articles/10.1186/s40463-020-00429-2 DB - PRIME DP - Unbound Medicine ER -