Observational study on healthcare workers protection in the angiographic suite during the SARS-CoV-2 pandemic: before and during vax era

ABSTRACT

Background: Since the first case of Coronavirus Disease 2019 (COVID-19) in Italy, all the hospital facilities had to reform their daily activities. Amidst them, the Interventional Radiology Department in the “Azienda Ospedaliera Universitaria” of Novara (Italy) had to create a dedicated protocol for the patent’s management during the pandemic.

Design and Methods
: The time interval between February 2020 and March 2021 was divided into three different periods and we reported the evolution of our safety protocol, the changes in our daily activities and the rates of Sars-CoV-2 infection among the healthcare workers (HCW) of the Angiographic Suite. Personnel who had positive partners/family members or who had established close contacts of another nature outside the workplace were excluded from the study, in order to reduce any bias.

Results: 
A total of 35 HCWs served in 355 patient procedures on Sars-CoV-2 positive patients from February 2020 to March 2021. During the year there was a reduction in the morbidity rate first from 7.9% to 1.4% and then currently reaching 0%.

Conclusions
: Dedicated routes, elevators, establishing Filter Areas and a clear demarcation between clean and contaminated areas, Dressing and undressing procedures, Cleaning procedures and the obligation to always wear a surgical mask during the working shift are essential to prevent in-hospital infection. The vaccines’ arrival seems to further reduce the risk for healthcare workers, but it is still necessary to take docile precautions in view of the new mutations of the virus.

REFERENCES

Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–33. DOI: https://doi.org/10.1056/NEJMoa2001017

World Health Organization. Risk assessment and management of exposure of health care workers in the context of COVID-19: interim guidance, 19 March 2020 . Available from: https://apps.who.int/iris/handle/10665/331496

Ferioli M, Cisternino C, Leo V, et al. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev 2020;29:200068. DOI: https://doi.org/10.1183/16000617.0068-2020

Mahase E. Covid-19: UK hospitals to get rapid tests from September. BMJ 2020;370:m3087. DOI: https://doi.org/10.1136/bmj.m3087

Elmiyeh B, Dwivedi RC, Jallali N, et al. Surgical voice restoration after total laryngectomy: an overview. Indian J Cancer 2010;47:239–47. DOI: https://doi.org/10.4103/0019-509X.64707

Workd Health Organization. Antigen-detection in the diagnosis of SARS-CoV-2 infection using rapid immunoassays Interim guidance, 11 September 2020. Available from: https://apps.who.int/iris/handle/10665/334253

Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603–15. DOI: https://doi.org/10.1056/NEJMoa2034577

Rostami A, Sepidarkish M, Leeflang MMG, et al. SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis. Clin Microbiol Infect 2021;27:331–40. DOI: https://doi.org/10.1016/j.cmi.2020.10.020

Ministero della Salute Italiano. Piano Vaccini anti Covid-19. Gazzetta Ufficiale. 2021.

Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, et al. A comprehensive review of COVID-19 characteristics. Biol Proced Online 2020;22:19. DOI: https://doi.org/10.1186/s12575-020-00128-2

Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Document on reporting chest CT findings related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging 2020;2:e200152. DOI: https://doi.org/10.1148/ryct.2020200152

Kokkinakis I, Selby K, Favrat B, et al. Covid-19 diagnosis: clinical recommendations and performance of nasopharyngeal swab-PCR. Rev Med Suisse 2020;16:699–701.

Chan JF-W, Yuan S, Kok K-H, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514–23. DOI: https://doi.org/10.1016/S0140-6736(20)30154-9

Tran K, Cimon K, Severn M, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One 2012;7:e35797. DOI: https://doi.org/10.1371/journal.pone.0035797

Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia 2021;76:174–81. DOI: https://doi.org/10.1111/anae.15292

Guimarães HP, Timerman S, Rodrigues RDR, et al. [Posicionamento para ressuscitação cardiopulmonar de pacientes com diagnóstico ou suspeita de COVID-19 – 2020].[Article in Portuguese]. Arq Bras Cardiol 2020;114:1078–87. DOI: https://doi.org/10.36660/abc.20200548

Perrone G, Giuffrida M, Bellini V, et al. Operating room setup: How to improve health care professionals safety during pandemic COVID-19—A Quality improvement study. J Laparoendosc Adv Surg Tech 2021;31:85–9. DOI: https://doi.org/10.1089/lap.2020.0592

Mossa-Basha M, Medverd J, Linnau KF, et al. Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington. Radiology 2020;296:E26–31. DOI: https://doi.org/10.1148/radiol.2019201326

Ministero della Salute Italiano. [Covid-19 – Situazione nel mondo].[in Italian]. Available from: https://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5338&area=nuovoCoronavirus&menu=vuoto

Ministero della Salute Italiano. [Covid-19 – Situazione in Italia].[in Italian]. Available from: https://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?area=nuovoCoronavirus&id=5351&lingua=italiano&menu=vuoto

Anderson EJ, Rouphael NG, Widge AT, Jet al. Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults. N Engl J Med 2020;383:2427–38. DOI: https://doi.org/10.1056/NEJMoa2028436

Chagla Z. In adults, the Oxford/AstraZeneca vaccine had 70% efficacy against COVID-19 >14 d after the 2nd dose. Ann Intern Med 2021;174:JC29. DOI: https://doi.org/10.7326/ACPJ202103160-029

Stephenson KE, Le Gars M, Sadoff J, et al. Immunogenicity of the Ad26.COV2.S Vaccine for COVID-19. JAMA 2021;325:1535-44. DOI: https://doi.org/10.1001/jama.2021.3645

Maria A, Bradford I, Chiara JW, et al. How to handle a COVID-19 patient in the angiographic suite. Cardiovasc Intervent Radiol 2020;43:820-6. DOI: https://doi.org/10.1007/s00270-020-02476-8

Zhao S, Ling K, Yan H, et al. Anesthetic management of patients with COVID 19 Infections during emergency procedures. J Cardiothorac Vasc Anesth 2020;34:1125–31. DOI: https://doi.org/10.1053/j.jvca.2020.02.039

Graham Carlos W, Dela Cruz CS, Cao B, et al. COVID-19: How do we stay safe? Am J Respir Crit Care Med 2020;202:15–6. DOI: https://doi.org/10.1164/rccm.2025P15

Mossa-Basha M, Meltzer CC, Kim DC, et al. Radiology department preparedness for COVID-19: Radiology scientific expert review panel. Radiology 2020;296:E106–12. DOI: https://doi.org/10.1148/radiol.2020200988

Xie X, Liu Y, Liu J, et al. Neutralization of SARS-CoV-2 spike 69 / 70 deletion, E484K and N501Y variants by BNT162b2 vaccine-elicited sera. Nat Med 2021;27:620-1. DOI: https://doi.org/10.1038/s41591-021-01270-4

Madhi SA, Baillie V, Cutland CL, et al. Efficacy of the ChAdOx1 nCoV-19 Covid-19 vaccine against the B.1.351 variant. N Engl J Med 2021;384:1885-98. DOI: https://doi.org/10.1056/NEJMoa2102214