key: cord-0804368-8svnnyta
authors: Bono, Francesco; Marchese, Roberta; Albanese, Alberto; De Cesaris, Francesco; Altavista, Maria Concetta; Eleopra, Roberto
title: Safety recommendations for treatment with botulinum toxin during the COVID-19 pandemic prepared by the Italian botulinum toxin network in collaboration with the accademia LIMPE-DisMov, SISC, and ANIRCEF associations
date: 2021-01-31
journal: Toxicon
DOI: 10.1016/j.toxicon.2020.11.358
sha: 35b8e9fa3324587d13592ee3d8d7eb5c3767a654
doc_id: 804368
cord_uid: 8svnnyta

nan

Overview: In order to minimize the risk of virus transmission in the era of COVID-19, the Italian Botulinum Toxin Network, in collaboration with Accademia LIMPE-DisMov, ANIRCEF, and SISC, propose recommendations for good practice in performing botulinum toxin injections.

Daily sanitization of areas to be used for botulinum toxin injections Take the patient's body temperature at the entrance to the facility. Maintain appropriate social distancing in the waiting room. Provide healthcare personnel with personal protective equipment (PPE), such as surgical or FFP2 masks, footwear, headgear, disposable gowns, gloves and visors/glasses, and sanitizing agents. 1 Provide patients with disposable materials, hand disinfectant, and surgical masks.

Come to the outpatient clinic with a protective surgical mask and nitrile gloves. (this also applies to persons accompanying patients) The person accompanying the patient must wear the protective surgical mask and, after delivering the patient, must wait outside the clinic or hospital during botulinum toxin treatment. Related to the Procedure:

The patient must disinfect the hands with hydroalcoholic or chlorine gel before entering the clinic. It is mandatory for the patient to wear non-sterile gloves and a surgical mask. Doctor and staff must remove all jewelry and personal items. Wash hands for at least 20 seconds with soap and water or alcohol solution. Put on the first pair of gloves. Put on footwear and headgear, then the disposable gown over the uniform, then a FFP2 mask; put on goggles or visor and the second pair of gloves. 2 When finished with a patient and moving on to the next, follow the sequence indicated. Remove the second pair of gloves together with the disposable gown; remove the goggles or visor and sanitize them. Practice hand hygiene using soap and water or alcohol solution. In addition, if the botulinum toxin injection procedure involves the craniocervical area or near the oral cavity, it is mandatory that Carers' Global Impression of Change Scale (GICS) mean ratings for 2-to 5-yearolds. GICS 7-point scale from -3 (very much worse) to +3 (very much improved).

Toxicon 190 (2020) S9 healthcare professionals change the FFP2 mask after each injection session, unless a protective visor is used. When finished with a patient and moving on to the next, clean all surfaces with which the patient has come into contact (eg, bed, chair) with hydroalcoholic disinfectants (70% ethyl alcohol) or chlorinebased disinfectants (0.1% sodium hypochlorite solutions). The most frequently handled surfaces should be protected with disposable barriers, which should be disposed of in special waste containers at the end of the session. in Portugal. We analyzed how many appointments were suspended and the extent of the delay of those that were rescheduled. Also, we compared the number of treatments that took place in that period with the number during the previous year.

Results: In the first three months of the COVID-19 outbreak, all scheduled treatments were either suspended or rescheduled. After that, there was a progressive return of the treatments, starting with the rescheduled ones (n¼23) that took place with 2 to 6 months of delay. There were also some patients who missed their appointments (n¼7) or that were discharged due to clinical reasons (n¼12). By the end of the first semester, the total number of treatments, although with no immediate side effects noted, was about 50% less than the previous year.

Conclusions: The reorganization of non-urgent clinical activities that occurred due to the COVID-19 pandemic led to the interruption or delay of spasticity treatments. In the present study, the first three months had more repercussions, with a complete suspension of treatments, that were partially recovered in the second trimester. All the treatments that took place in the first semester had no immediate complications recorded, which is a good preliminary indicator of the safety of BoNT-A treatment during the COVID-19 outbreak, but further studies are needed. 

Personal protective equipment and Covid-19

COVID-19): using personal protective equipment (PPE

Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1

Appendix: Italian Botulinum Toxin Network Safe Infiltration Project participants

SPASTICITY TREATMENT WITH BOTULINUM TOXIN DURING THE COVID-19 PANDEMIC

Methods: The Allergan Global Safety Database contains reports of ona-botulinumtoxinA administration before/during pregnancy, including prospective (reported before outcome known) and retrospective (outcome known when reported) cases. The database was searched (1/1/90-12/31/ 18) for eligible cases where treatment occurred during pregnancy or 3 months prior to conception. To minimize reporting bias, prevalence rates for overall and major birth defects were estimated from prospective cases of live births only. Results: Of 913 pregnancies, 397 (43.5%) were eligible with known outcomes. Maternal age was known in 215 cases, with 45.6% of mothers 35 years. Indication was known in 340 cases, with the most frequent being cosmetic (35.3%), migraine/headache (30.3%), and movement disorders (12.1%)

Conclusions: This 29-year retrospective analysis of safety data in onabo-tulinumtoxinA-exposed mothers demonstrated that the prevalence rate of