key: cord-0999099-0p5w00us
authors: Axiotakis, Lucas G.; Boyett, Deborah M.; Youngerman, Brett E.; McKhann, Guy M.; Lalwani, Anil K.
title: SARS-CoV-2 transmission rate is low when following a COVID+ patient in the operating room
date: 2021-02-06
journal: Langenbecks Arch Surg
DOI: 10.1007/s00423-021-02085-0
sha: fc29d6e58f707cfaec87611bb1cf892bcac87d16
doc_id: 999099
cord_uid: 0p5w00us

PURPOSE: Acquiring SARS-CoV-2 infection for uninfected patients undergoing surgical procedures following a COVID positive (COVID+) patient is of significant concern, both for patients seeking medical care in hospital settings and for management of surgical services during pandemic times. METHODS: Using data identifying all COVID+ surgical patients during the initial pandemic peak in New York City (March 15 to May 15, 2020), we analyzed the rate of postoperative symptomatic SARS-CoV-2 infection in COVID negative (COVID−) patients undergoing surgery in the same operating room within 48 h, thus determining nosocomial symptomatic infection rate attributable to COVID operating room exposure. RESULTS: Five COVID− patients directly followed a COVID+ patient, while 19 patients were exposed to COVID+ operating rooms within 24 h. By 48 h, 21 additional patients were exposed. No exposed patients acquired symptomatic SARS-CoV-2 infection postoperatively. CONCLUSION: With implementation of infection prevention and control procedures in the operating room under local pandemic conditions, our findings suggest that the risk of acquiring SARS-CoV-2 infection, when following a COVID+ patient in the same operating room, is very low.

During the current global coronavirus disease 2019 (COVID-19) pandemic, acquiring SARS-CoV-2 infection in the hospital is of significant concern for patients needing acute care. In the operating room (OR), aerosolized SARS-CoV-2 particles and those surviving on surfaces for extended periods (>48 h) are worrisome for nosocomial transmission [1] [2] [3] . This is particularly concerning for COVID negative (COVID−) patients undergoing invasive surgical procedures immediately following COVID positive (COVID+) patients in the same OR.

To minimize risk of SARS-CoV-2 transmission between surgical cases during the pandemic, hospitals have implemented infection prevention and control procedures specific to the OR environment, including designating COVID ORs, instituting routine "terminal" cleaning of the OR (i.e., protocols normally performed at the end of the day including disinfecting all vertical and horizontal surfaces, equipment, and receptacles), delaying entry to the room by 30-minutes to effect >99.9% air turnover, and placing viral filters in the expiratory limb of the circuit and between the breathing circuit and the patient's airway to prevent Drs. McKhann and Lalwani share senior authorship for this work.

Previous use: The definitions and identification of patient subpopulations based on pre-and post-operative COVID status were used in another study by our group (PMID: 33156061) examining perioperative SARS-CoV-2 infection and was carried forward for the purposes of the current work focusing on transmission due to operating room exposure. transmission via ventilators. Despite these measures, their effectiveness in preventing transmission due to OR exposure is unclear. Herein, we investigate the risk of acquiring perioperative SARS-CoV-2 infection when a COVID− patient follows a COVID+ patient in the same OR.

All index surgeries occurring at Columbia University during the initial peak of the COVID-19 pandemic, from M a r c h 1 5 t o M a y 1 5 , 2 0 2 0 , w e r e a n a l y z e d . Preoperatively and postoperatively, patients were considered COVID+ if they tested positive or had 2+ of 7 symptoms based on Centers for Disease Control (CDC) guidelines [4] . Exposure to SARS-CoV-2 was defined as surgery occurring after a COVID+ patient in the same OR up to 48 h postoperatively; therefore, a COVID− patient could undergo surgery in the same operating room as no COVID+ patients, one COVID+ patient, or greater than one COVID+ patient within this timeframe. "Exposure" for the COVID− patient was defined as the number of Table 1 includes all individual instances of exposures to specific COVID+ ORs (n = 57). Number of patients exposed (n = 45) is not shown; this difference is accounted for by n = 9 patients who were exposed to COVID+ ORs on >1 occasion within 48 h *Time elapsed between a COVID+ patient undergoing surgery followed by a COVID− in the same OR was stratified by (row 1) the next case in the COVID+ OR within the same day, (row 2) within 24 h but not directly following a COVID+ cases within the same day, and ( (Fig. 1 ).

With continued increases in hospitalized COVID-19 patients throughout various areas of the USA, hospitalacquired SARS-CoV-2 infection remains a significant concern. In addition to OR-specific safety measures, surgical services have adopted a multitude of approaches aimed at reducing nosocomial infection, including but not limited to performing emergent procedures only, decreasing overall caseload and ORs in use, and instituting mandatory screening to inform triage and preoperative decision-making [5, 6] . Nonetheless, on occasion, when a COVID− patient follows in a room where a COVID+ patient underwent surgery, transmission concerns remain high. In this study, we show that, under these circumstances, the risk of symptomatic COVID infection is very low. Our finding suggests that the infection prevention and control procedures implemented within ORs have been effective in minimizing COVID transmission among surgical patients; this finding may help alleviate patient concerns of nosocomial SARS-CoV-2 infection, especially when inpatient and surgical care is necessary during the pandemic. Ostensibly, exposure to COVID of the small cohort of patients acquiring symptomatic infection perioperatively occurred in other areas of the hospital environment, or in the community at large. This study is limited by its retrospective nature and reliance on chart review for diagnosis, evolution of protocols during the study period, and inability to assess the COVID status of OR staff.

With thorough implementation of infection prevention and control procedures in the OR, our findings suggest that the risk of symptomatic infection following a COVID+ patient in the same OR is very low.

Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic?

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

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Global guidance for surgical care during the COVID-19 pandemic

Maximizing the calm before the storm: tiered surgical response plan for novel coronavirus (COVID-19)

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Author contribution AKL and GMM conceived of the study. AKL, GMM, LGA, DMB, and BEY performed data collection, analysis, and interpretation. All authors contributed meaningfully to and approved of the final manuscript.Availability of data and material The de-identified data analyzed in this study is available upon reasonable request.Code availability Not applicable.

Ethics approval The data analyzed in this study was collected as part of Columbia University Institutional Review Board protocol #AAAT0618.

The authors declare that they have no conflict of interest.