Minimizing SARS-CoV-2 exposure when performing surgical interventions during the COVID-19 pandemic.
Betacoronavirus
COVID-19
Coronavirus Infections
/ surgery
Health Personnel
/ standards
Humans
Infectious Disease Transmission, Patient-to-Professional
/ prevention & control
Neurosurgical Procedures
/ adverse effects
Operating Rooms
/ methods
Pandemics
Personal Protective Equipment
/ standards
Pneumonia, Viral
/ surgery
SARS-CoV-2
aneurysm
arteriovenous malformation
hemorrhage
infection
standards
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
11
04
2020
revised:
28
04
2020
accepted:
29
04
2020
pubmed:
22
5
2020
medline:
24
6
2020
entrez:
22
5
2020
Statut:
ppublish
Résumé
Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.
Sections du résumé
BACKGROUND
BACKGROUND
Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences.
METHODS
METHODS
We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment.
RESULTS
RESULTS
Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas.
CONCLUSION
CONCLUSIONS
Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.
Identifiants
pubmed: 32434798
pii: neurintsurg-2020-016161
doi: 10.1136/neurintsurg-2020-016161
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
643-647Investigateurs
Mark Bain
(M)
Bernard Bendock
(B)
Alan S Boulos
(AS)
Webster Crowley
(W)
Richard Fessler
(R)
Andrew Grande
(A)
Lee Guterman
(L)
Ricardo Hanel
(R)
L Daniel Hoit
(L)
Nelson Hopkins
(N)
Jay Howington
(J)
Robert James
(R)
Brian Jankowitz
(B)
Alex A Khalessi
(AA)
Giuseppe Lanzino
(G)
Demetrius Lopes
(D)
William Mack
(W)
Robert Mericle
(R)
Chris Ogilvy
(C)
Robert Replogle
(R)
Rafael Rodriguez
(R)
Eric Saugaveau
(E)
Alex Spiotta
(A)
Ali Sultan
(A)
Rabih Tawk
(R)
Ajith Thomas
(A)
Raymond Turner
(R)
Babu Welch
(B)
Jonathan White
(J)
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: There are no competing interests for any author.