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Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic.
Anesth Analg. 2020 11; 131(5):1342-1354.A&A

Abstract

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.

Authors+Show Affiliations

From the Department of Anesthesiology, University of Washington, Seattle, Washington.From the Department of Anesthesiology, University of Washington, Seattle, Washington.Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington.Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33079853

Citation

Bowdle, Andrew, et al. "Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic." Anesthesia and Analgesia, vol. 131, no. 5, 2020, pp. 1342-1354.
Bowdle A, Jelacic S, Shishido S, et al. Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. Anesth Analg. 2020;131(5):1342-1354.
Bowdle, A., Jelacic, S., Shishido, S., & Munoz-Price, L. S. (2020). Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. Anesthesia and Analgesia, 131(5), 1342-1354. https://doi.org/10.1213/ANE.0000000000005169
Bowdle A, et al. Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. Anesth Analg. 2020;131(5):1342-1354. PubMed PMID: 33079853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. AU - Bowdle,Andrew, AU - Jelacic,Srdjan, AU - Shishido,Sonia, AU - Munoz-Price,L Silvia, PY - 2020/10/20/entrez PY - 2020/10/21/pubmed PY - 2020/10/29/medline SP - 1342 EP - 1354 JF - Anesthesia and analgesia JO - Anesth Analg VL - 131 IS - 5 N2 - Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/33079853/Infection_Prevention_Precautions_for_Routine_Anesthesia_Care_During_the_SARS_CoV_2_Pandemic_ L2 - https://doi.org/10.1213/ANE.0000000000005169 DB - PRIME DP - Unbound Medicine ER -