In the absence of SARS-CoV-2 specific evidence, recommendations for fallow time following AGPs in the context of the SARS-CoV-2 pandemic range widely depending on country and specialty association.
The majority of recommendations are based upon dental practices and several on thoracic surgical practice.
The most common recommendations follow the CDC’s guidelines for airborne contamination removal based on air changes per hour ventilation properties of rooms.
Assuming that most treatment rooms have a minimum of 10-12 ACH, most associations recommend a 20-minute fallow periods, or 60 minutes if ACH is unknown or below recommendations for treatment rooms.
Badea, A; Groot G; Dalidowicz, M; Young, C; Miller, L. What are the recommendations around settling times following aerosol generating procedures on suspected or confirmed COVID-19 patients? 2020 Dec 1; Document no.: EOC081401v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 24 p. (CEST rapid review report)
· The Intubation box was originally invented by Dr. Lai Hsien-yung, an anesthesiologist in Taiwan.
· The main function of the intubation box is intended to prevent exposure of care providers to COVID-19 from aerosol droplets during intubation.
· The intubation box concept emerged during the pandemic to address the challenge of adequate supply of PPEs in resource limited settings in particular but presents limitations and poses significant safety risk to the patient.
· limitations include increased incubation time, discomfort from restricted hand movements for the intubation procedure, reduced first-pass intubation rates, limitation for certain body habitus and possible injury to patient
· With regards to aerosol exposure, intubation boxes have been reported to increase rather than decrease airborne particle exposure.
Asamoah, G; Groot, G; Badea, A; Ellsworth, C; Fox, L. What are the safety risks or disinfection concerns with the use of intubation boxes? 2020 Sep 8; Document no.: EOC090202 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 13 p. (CEST rapid review report)
· Small simulation studies have demonstrated potential contamination of neck and back area
· Many associations recommend neck coverage, or if unavailable to ensure sanitation/washing of exposed skin after doffing PPE
· Several warnings that increasing amount of PPE increases chances of contamination and may decrease level of compliance
Badea, A; Groot, G; Dalidowicz, M; Miller, L. Do neck or back coverings provide additional protection to gown and N95 mask when conducting an aerosol generating procedure? 2020 May 15; Document no.: EOC051201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 9 p. (CEST rapid review report)
· There are some recommendations and precautions from WHO, CDC, Canada and the UK that there is transmission of the COVID virus from the administration of nebulizer medication.
· Some case studies of SARS found few instances that patients may likely be infected after aerosol generating procedures including nebulized medications, and although there are few evidences that demonstrates low risk of viral transmission from nebulizers, possibility of transmission remains
Badea, A; Groot, G; Fenton, M; Dalidowicz, M; Young, C. What is the degree of COVID-19 transmission through the administration of nebulizer medication either in clinical practice or in animal experiments? 2020 Apr 1; Document no.: EOC040101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 10 p. (CEST rapid review report)
· Some countries like Taiwan and Malaysia have created their own intubation hood design as others offered to produce or modify the original design to fit their country’s equipment.
· Several countries have also created innovation in airway management such as 3D printed respirator valves for hospitals and 3D printed ventilators.
· An Emergency physician in Northern Italy shared that due to influx of patients in the hospitals, “intubation and invasive mechanical ventilators in the ED are reserved for patients not responsive to NIV” although in principle can give a more favorable chance for patients if given before their condition deteriorates.
Badea, A; Groot, G; Dalidowicz, M. Where and how are they producing and using intubation hoods? 2020 Mar 30; Document no.: EOC033001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 7 p. (CEST rapid review report)
