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2020 ; 134
(ä): 110075
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Operative team checklist for aerosol generating procedures to minimise exposure
of healthcare workers to SARS-CoV-2
#MMPMID32388083
Soma M
; Jacobson I
; Brewer J
; Blondin A
; Davidson G
; Singham S
Int J Pediatr Otorhinolaryngol
2020[Jul]; 134
(ä): 110075
PMID32388083
show ga
OBJECTIVES: In many countries around the world, the COVID-19 pandemic has
resulted in health services being diverted to manage patients with the condition.
There are situations however that still require the undertaking of aerosol
generating procedures (AGP) with potentially high exposure of healthcare workers
to SARS-CoV-2 transmission through droplet, contact and possibly airborne routes.
The objective of this paper is to explore a structured way for the operative team
to approach AGP to reduce aerosolisation of secretions, decrease open airway time
and minimise staff exposure. METHODS: The authors (otolaryngologists,
anaesthetists and nursing staff) created a unified operative team checklist based
on collation of national and international specialty society statements, local
state government recommendations, hospital policies and literature review.
Simulation was undertaken and the checklist was refined after performing AGP on
patients with unknown (presumed positive) COVID-19 status. RESULTS: An 8 step
operative team checklist is provided describing details for the immediate
pre-operative, intra-operative and post-operative journey of the patient to
encourage healthcare workers to reflect upon and modify usual practice during AGP
to mitigate exposure to SARS-CoV-2. The example of paediatric
laryngo-bronchoscopy for diagnostic purposes or retrieval of an inhaled airway
foreign body is used to illustrate the steps however the checklist structure is
modifiable for other AGP and adaptable for local needs. CONCLUSIONS: At a time of
overwhelming and changing information and recommendations, an operative team
checklist may provide some structure to healthcare workers undertaking AGP to
reduce anxiety, maintain focus, prompt consideration of alternatives and
potentially reduce risk.