COVID-19 Transmission to Health Care Personnel During Tracheostomy Under a Multidisciplinary Safety Protocol

Author:

Standiford Taylor C.1,Farlow Janice L.2,Brenner Michael J.3,Blank Ross4,Rajajee Venkatakrishna5,Baldwin Noel R.6,Chinn Steven B.7,Cusac Jessica A.8,De Cardenas Jose9,Malloy Kelly M.10,McDonough Kelli L.11,Napolitano Lena M.12,Sjoding Michael W.13,Stoneman Emily K.14,Washer Laraine L.15,Park Pauline K.16

Affiliation:

1. Taylor C. Standiford is a second-year resident, Department of Otolaryngology–Head & Neck Surgery, University of California, San Francisco.

2. Janice L. Farlow is a head and neck surgical oncology fellow, Department of Otolaryngology–Head & Neck Surgery, The Ohio State University, Columbus.

3. Michael J. Brenner is an associate professor, Department of Anesthesiology, University of Michigan, Ann Arbor.

4. Ross Blank is an assistant professor, Department of Anesthesiology, University of Michigan, Ann Arbor.

5. Venkatakrishna Rajajee is a professor, Department of Neurosurgery, University of Michigan, Ann Arbor.

6. Noel R. Baldwin is a registered nurse, Critical Care Medicine Unit, University of Michigan, Ann Arbor.

7. Steven B. Chinn is an assistant professor, Department of Otolaryngology–Head & Neck Surgery, University of Michigan, Ann Arbor.

8. Jessica A. Cusac is a respiratory therapist, clinical specialist, University Hospital/Cardiovascular Center, University of Michigan, Ann Arbor.

9. Jose De Cardenas is an associate professor Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor.

10. Kelly M. Malloy is an associate professor, Department of Otolaryngology–Head & Neck Surgery, University of Michigan, Ann Arbor.

11. Kelli L. McDonough is a clinical research project manager, Department of Surgery, University of Michigan, Ann Arbor.

12. Lena M. Napolitano is a professor, Department of Surgery, University of Michigan, Ann Arbor.

13. Michael W. Sjoding is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor.

14. Emily K. Stoneman is an associate professor, Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor.

15. Laraine L. Washer is a professor, Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor.

16. Pauline K. Park is a professor, Department of Surgery, University of Michigan, Ann Arbor.

Abstract

Background Tracheostomies are highly aerosolizing procedures yet are often indicated in patients with COVID-19 who require prolonged intubation. Robust investigations of the safety of tracheostomy protocols and provider adherence and evaluations are limited. Objectives To determine the rate of COVID-19 infection of health care personnel involved in COVID-19 tracheostomies under a multidisciplinary safety protocol and to investigate health care personnel’s attitudes and suggested areas for improvement concerning the protocol. Methods All health care personnel involved in tracheostomies in COVID-19–positive patients from April 9 through July 11, 2020, were sent a 22-item electronic survey. Results Among 107 health care personnel (80.5%) who responded to the survey, 5 reported a positive COVID-19 test result (n = 2) or symptoms of COVID-19 (n = 3) within 21 days of the tracheostomy. Respondents reported 100% adherence to use of adequate personal protective equipment. Most (91%) were familiar with the tracheostomy protocol and felt safe (92%) while performing tracheostomy. Suggested improvements included creating dedicated tracheostomy teams and increasing provider choices surrounding personal protective equipment. Conclusions Multidisciplinary engagement in the development and implementation of a COVID-19 tracheostomy protocol is associated with acceptable safety for all members of the care team.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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