Abstract
BackgroundTracheostomy, as an aerosol-generating procedure, is considered as a high-risk surgery for health care workers (HCWs) during the coronavirus disease (COVID-19) pandemic. Current recommendations are to perform tracheostomy after a period of intubation of > 14 days, with two consecutive negative throat swab tests, to lower the risk of contamination to HCWs. However, specific data for this recommendation are lacking. Therefore, this study aimed to evaluate viral shedding into the environment, including HCWs, associated with bedside tracheostomy in the intensive care unit.MethodsSamples obtained from the medical environment immediately after tracheostomy, including those from 19 surfaces, two air samples at 10 and 50 cm from the surgical site, and from the personal protective equipment (PPE) of the surgeon and assistant, were tested for the presence of severe acute respiratory syndrome coronavirus 2 in eight cases of bedside tracheostomy. We evaluated the rate of positive tests from the different samples obtained.ResultsPositive samples were identified in only one of the eight cases. These were obtained for the air sample at 10 cm and from the bed handrail and urine bag. There were no positive test results from the PPE samples. The patient with positive samples had undergone early tracheostomy, at 9 days after intubation, due to a comorbidity.ConclusionsOur preliminary results indicate that delayed tracheostomy, after an extended period of endotracheal intubation, might be a considerably less contagious procedure than early tracheostomy (defined as < 14 days after intubation).
Highlights
Tracheostomy, as an aerosol-generating procedure, is considered as a high-risk surgery for health care workers (HCWs) during the coronavirus disease (COVID-19) pandemic
There is a lack of direct supporting evidence regarding the safety of this suggestion with regard to the risk for infection. To address this current gap in practical knowledge, we evaluated the risk of SARS-CoV-2 contamination in samples collected from HCWs and surfaces in proximity of patients who underwent bedside tracheostomy in the intensive care unit
Patient 7 was diagnosed with cerebral hemorrhage at the time of intubation and underwent tracheostomy 9 days after endotracheal intubation, and 33 days after COVID-19 symptom onset
Summary
Tracheostomy, as an aerosol-generating procedure, is considered as a high-risk surgery for health care workers (HCWs) during the coronavirus disease (COVID-19) pandemic. As of January 1, 2021, over 80 million cases of coronavirus disease (COVID-19) have been reported globally, severely burdening health care systems. The severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) has been identified as the cause of this highly contagious disease [1]. The primary morbidity associated with COVID-19 is acute respiratory distress syndrome, which may require invasive mechanical ventilation, including tracheostomy [7]. As an aerosol-generating procedure, tracheostomy is usually associated with high droplet and particle generation, which has been considered as one of the highest contamination risks for health care workers (HCWs) during the COVID-19 pandemic [8, 9]. This information could guide decision-making regarding the indications
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