Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other perso
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TECHNICAL NOTE
Preventing transmission among operating room staff during COVID‑19 pandemic: the role of the Aerosol Box and other personal protective equipment F. Bianco1 · P. Incollingo1 · U. Grossi2 · G. Gallo3 Received: 5 May 2020 / Accepted: 20 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called “Aerosol Box” (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP. Keywords COVID-19 pandemic · Personal protective equipment · Aerosol Box · Aerosol-generating medical procedures · Operating room
Introduction The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in the emergency departments [1, 2]. Secondary transmission occurs primarily via inhalation of droplets or airborne particle transmission and is common in the hospital setting [3]. During aerosol-generating medical procedures (AGMP), the production of both airborne particles and droplets may increase the risk of infection. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) defined a list of AGMP, during which the use of personal protective * G. Gallo [email protected] 1
General Surgery Unit, S. Leonardo Hospital, Castellammare Di Stabia, Napoli, Italy
2
4th Surgery Unit, Treviso Regional Hospital, Treviso, Italy
3
Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
equipment (PPE) should be recommended for all involved theater staff [4, 5]. PPE consists of head covering, eye protection, N95 mask, gloves, and long-sleeved gowns [6]. The main determinant of the risk of contagion is the total viral load in the secretions to whom the healthcare workers are exposed. For this reason, it is strongly recommended to limit as much as possible the period of close-proximity to the patients. With this regard, the “Aerosol Box” (AB) has been claimed as a valuable protective resource during open suctioning of airways and endotracheal int
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