BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Otolaryngology-Head and Neck Surgery, BC Rotary Hearing and Balance Centre, St. Paul's Hospital, 1081 Burrard St, Vancouver, B.C, V6Z 1Y6, Canada.
J Otolaryngol Head Neck Surg. 2020 Jun 3;49(1):36. doi: 10.1186/s40463-020-00429-2.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for Coronavirus disease 2019 (COVID-19) has a predilection for infecting the mucosa of the upper and lower airways. Otolaryngologists and supporting health care workers (HCWs) are particularly at high risk of becoming infected while treating patients as many in-office procedures and surgeries are Aerosol Generating Medical Procedures (AGMP). Based on a review of the literature and various guidelines, recommendations are made to mitigate the risk to health care workers of becoming infected with SARS-CoV-2 while providing clinical care.
During the COVID-19 pandemic all elective and non-time sensitive Otolaryngology procedures should be deferred to mitigate the risk of transmission of infection to HCWs. For non-AGMPs in all patients, even COVID-19 positive patients Level 1 PPE (surgical mask, gown, gloves and face shield or goggles) is sufficient. If local prevalence is favourable and patients are asymptomatic and test negative for SARS-CoV-2, Level 1 PPE can be used during short duration AGMPs, with limited risk of infected aerosol spread. For AGMPs in patients who test positive for SARS-CoV-2 a minimum of Level 2 PPE, with adequate protection of mucosal surfaces, is recommended (N95/FFP2 respirator, gown, double gloves, goggles or face shield and head cover). For long duration AGMPs that are deemed high-risk in COVID-19 positive patients, Level 3 PPE can provide a higher level of protection and be more comfortable during long duration surgeries if surgical hoods or PAPRs are used. It is recommended that these procedures are performed in negative pressure rooms, if available. It is essential to follow strict donning and doffing protocols to minimize the risk of contamination.
By following strict infection prevention recommendations, the risk of HCWs becoming infected with SARS-CoV-2 while treating patients can be minimized. As the COVID-19 pandemic evolves rapidly, these recommendations should serve as guidance and need to be interpreted based on local factors and availability of healthcare resources.
导致 2019 年冠状病毒病（COVID-19）的严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）倾向于感染上呼吸道和下呼吸道的黏膜。耳鼻喉科医生和支持的医护人员（HCW）在治疗患者时感染的风险特别高，因为许多门诊程序和手术都是气溶胶产生的医疗程序（AGMP）。基于对文献和各种指南的审查，提出了建议，以减轻 HCW 在提供临床护理时感染 SARS-CoV-2 的风险。
在 COVID-19 大流行期间，应推迟所有非紧急和非时间敏感的耳鼻喉科手术，以减轻向 HCW 传播感染的风险。对于所有患者的非 AGMP，即使是 COVID-19 阳性患者，一级 PPE（手术口罩、长袍、手套和面罩或护目镜）就足够了。如果当地流行情况有利，且患者无症状且 SARS-CoV-2 检测呈阴性，在短时间内进行 AGMP 时，可以使用一级 PPE，感染气溶胶传播的风险有限。对于 SARS-CoV-2 检测呈阳性的患者进行 AGMP，建议使用至少二级 PPE，充分保护黏膜表面（N95/FFP2 呼吸器、长袍、双层手套、护目镜或面罩和头罩）。对于被认为 COVID-19 阳性患者风险较高的长时间 AGMP，可以使用三级 PPE 提供更高水平的保护，如果使用手术罩或 PAPR，则在长时间手术中更舒适。如果有条件，建议在负压室中进行这些程序。严格遵循穿戴和脱卸规范对于最大程度降低污染风险至关重要。
通过严格遵循感染预防建议，可以最大程度地降低 HCW 在治疗患者时感染 SARS-CoV-2 的风险。随着 COVID-19 大流行的迅速发展，这些建议应作为指导，并根据当地因素和医疗保健资源的可用性进行解释。
