CoVID - 19 en el Quirófano. ¿Cuál fue el impacto en el personal con el uso de un protocolo de seguridad?  <span class="so-article-trans-title" dir="auto"> Translated title: CoVID - 19 in the O.R. was the impact on staff with the security protocol use? </span>

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Abstract

Resumen Introducción. La pandemia por Coronavirus originada en 2019 fue reconocida como de alta contagiosidad y se definieron diferentes medidas de prevención de contagio. Objetivo: Evaluar su impacto en el personal de salud actuante en los quirófanos ante patologías quirúrgicas impostergables. Configuración y Diseño. Estudio observacional descriptivo prospectivo con análisis retrospectivo en el área quirúrgica desde 1/julio al 30/septiembre/2020. Material y Métodos. Se implementó́ un listado de verificación CoVID-19, en pacientes a operar sospechosos o confirmados con criterios del Ministerio de Salud de la Nación. Resultados. 582 personas intervinieron en el área quirúrgica para la asistencia de 80 pacientes CoVID- 19 positivo. El 74% de los procedimientos se realizó en urgencias. No hubo informes de infección/contagio de los participantes en la atención sanitaria de los pacientes positivos según relevamiento diario realizado por la División Infectologia. Conclusión. Trabajar en forma coordinada con acatamiento de protocolos especiales y equipamiento de protección personal adecuado define las reglas y procedimientos para documentar la no contagiosidad del personal actuante en la asistencia de pacientes CoVID-19 positivos con patologías quirúrgicas.

Translated abstract

Abstract Introduction. The Coronavirus pandemic originating in 2019 was recognized as highly contagious and different infection prevention measures were defined. Aims. Was to assess its impact on acting health workers in operating rooms against nonsuspend surgical pathologies. Settings and Design: Prospective descriptive observational study with retrospective analysis in the surgical area from 1/July to 30/September/2020. Methods and Material: A CoVID-19 checklist was implemented in patients to be operated on, suspected or confirmed with criteria of the Nation's Ministry of Public Health. Results. 582 people surgically intervened in the operating room area for the assistance of 80 CoVID-19 positive patients. 74% of the procedures were performed in unscheduled emergencies. No reports of infection/contagion of participants in the health care of positive patients according to the daily survey carried out by the Infectology Division. Conclusions. working in a coordinated manner with compliance, special protocols and adequate personal protection equipment manages defining the rules and procedures to certificate the non-contagiousness of workers in the care of CoVID-19 patients positive with surgical pathologies.

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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A pneumonia outbreak associated with a new coronavirus of probable bat origin

Peng Zhou, Xing-Lou Yang, Xian-Guang Wang … (2020)

Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.

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Viral load of SARS-CoV-2 in clinical samples

Yang Pan, Daitao Zhang, Peng Yang … (2020)

An outbreak caused by a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in Wuhan in December 2019, 1 and has since spread within China and to other countries. Real-time RT-PCR assays are recommended for diagnosis of SARS-CoV-2 infection. 2 However, viral dynamics in infected patients are still yet to be fully determined. Here, we report our findings from different types of clinical specimens collected from 82 infected individuals. Serial samples (throat swabs, sputum, urine, and stool) from two patients in Beijing were collected daily after their hospitalisation (patient 1, days 3–12 post-onset; patient 2, days 4–15 post-onset). These samples were examined by an N-gene-specific quantitative RT-PCR assay, as described elsewhere. 3 The viral loads in throat swab and sputum samples peaked at around 5–6 days after symptom onset, ranging from around 104 to 107 copies per mL during this time (figure A, B ). This pattern of changes in viral load is distinct from the one observed in patients with SARS, which normally peaked at around 10 days after onset. 4 Sputum samples generally showed higher viral loads than throat swab samples. No viral RNA was detected in urine or stool samples from these two patients. Figure Viral dynamics of SARS-CoV-2 in infected patients Viral load (mean [SD]) from serial throat swab and sputum samples in patient 1 (A) and patient 2 (B). (C) Viral load (median [IQR]) in throat and sputum samples collected from 80 patients at different stages after disease onset. (D) Correlation between viral load in throat swab samples and viral load in sputum samples. We also studied respiratory samples (nasal [n=1] and throat swabs [n=67], and sputum [n=42]) collected from 80 individuals at different stages of infection. The viral loads ranged from 641 copies per mL to 1·34 × 1011 copies per mL, with a median of 7·99 × 104 in throat samples and 7·52 × 105 in sputum samples (figure C). The only nasal swab tested in this study (taken on day 3 post-onset) showed a viral load of 1·69 × 105 copies per mL. Overall, the viral load early after onset was high (>1 × 106 copies per mL). However, a sputum sample collected on day 8 post-onset from a patient who died had a very high viral load (1·34 × 1011 copies per mL). Notably, two individuals, who were under active surveillance because of a history of exposure to SARS-CoV-2-infected patients showed positive results on RT-PCR a day before onset, suggesting that infected individuals can be infectious before them become symptomatic. Among the 30 pairs of throat swab and sputum samples available, viral loads were significantly correlated between the two sample types for days 1–3 (R2=0·50, p=0·022), days 4–7 (R2=0·93, p<0·001), and days 7–14 (R2=0·95, p=0·028). From 17 confirmed cases of SARS-CoV-2 infection with available data (representing days 0–13 after onset), stool samples from nine (53%; days 0–11 after onset) were positive on RT-PCR analysis. Although the viral loads were less than those of respiratory samples (range 550 copies per mL to 1·21 × 105 copies per mL), precautionary measures should be considered when handling faecal samples.

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Journal

Journal ID (publisher-id): jonnpr

Title: Journal of Negative and No Positive Results

Abbreviated Title: JONNPR

Publisher: Research and Science S.L. (Madrid, Madrid, Spain )

ISSN (Electronic): 2529-850X

Publication date (Print and electronic): 2021

Volume: 6

Issue: 6

Pages: 860-871

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[1] Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Hospital de Clínicas orgdiv2Departamento de Cirugía Argentina

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Publisher ID: S2529-850X2021000600860 Publisher ID: S2529-850X(21)00600600860

DOI: 10.19230/jonnpr.4153

SO-VID: 0d794fb5-8d7a-438e-8b31-230c638573b3

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Date received : 10 December 2020

Date accepted : 29 January 2021

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CoVID - 19 en el Quirófano. ¿Cuál fue el impacto en el personal con el uso de un protocolo de seguridad? Translated title: CoVID - 19 in the O.R. was the impact on staff with the security protocol use?

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Novel Coronavirus Disease COVID-19

Most cited references 23

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

A pneumonia outbreak associated with a new coronavirus of probable bat origin

Viral load of SARS-CoV-2 in clinical samples

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