key: cord-0702293-z0sbgjqp
authors: Loftus, Randy W.; Dexter, Franklin; Evans, Lance C.; Robinson, Alysha D.M.; Odle, Abby; Perlman, Stanley
title: An assessment of the impact of recommended anesthesia work area cleaning procedures on intraoperative SARS-CoV-2 contamination, a case-series analysis
date: 2021-05-25
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2021.110350
sha: a574c9a2a09b4a5f7783e543fc63ffef7c3f84a7
doc_id: 702293
cord_uid: z0sbgjqp

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hypothesis that ultraviolet-C germicidal irradiation (UV-C) would augment surface disinfection cleaning [2, 3] . This work extends simulated study of sterile dye [4, 5] to the assessment of actual SARS-CoV-2 nucleic acid transmission in the operating room theatre.

Perioperative COVID-19 recommendations [1] were implemented in April 2020, 7 months prior to enrollment of the first of 11 patients ( Table 1 ) at the University of Iowa. Adult patients confirmed positive for COVID-19 by real-time PCR analysis preoperatively within 90 days of surgery were considered eligible for enrollment. For each patient enrolled we assessed in parallel the effectiveness of recommended anesthesia work area cleaning procedures, the rate of within-case anesthesia work area SARS-CoV-2 transmission, and environmental SARS-CoV-2 detection with and without Helios UV-C (Surfacide, Waukesha WI 53186). We evaluated thirteen proven AWA reservoirs [1] and twelve proximal and distal environmental locations [4] [5] [6] (before surface disinfection cleaning, after surface disinfection cleaning, and after surface disinfection cleaning and UV-C) for each enrolled patient to test our primary and secondary hypotheses, respectively. The effectiveness of recommended cleaning procedures was defined a priori by an anesthesia work area S. aureus transmission rate of <12.5% [7] . S. aureus and SARS-CoV-2 transmission events were defined by reservoir detection at case end but not at case start or by detection among ≥ 2 distinct reservoirs [1, 7] . SARS-CoV-2 detection was defined by the amplification of at least 2 SARS-CoV-2 genes (ORF, N, S) by visual inspection of amplification plots with CT (cycle threshold) < 35 [8] . See supplementary material for additional detail regarding sample locations, sampling and microbiological methodology, and assessment of infectivity.

We relied on our secondary hypothesis for sample size calculations given lack of available data for the primary hypothesis. We hypothesized that less SARS-CoV-2 nucleic acid detection would be observed after UV-C than after surface disinfection for every patient. With negative pairwise differences for all of 9 patients, P = 0.0020 for a reduction. We anticipated the possibility of patients for which none of the 12 samples detected SARS-CoV-2 in the period after cleaning but before UV-C treatment. If that were so for 3 patients (i.e., there are 6 differences that aren't both zero valued), P = 0.016. Therefore, the basis for our selection of N = 9 patients was that this provided for up to 3 patients to have 0 of 12 samples positive after cleaning. We 

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