SARS-CoV-2 environmental contamination from hospitalised patients with COVID-19 receiving aerosol-generating procedures

BackgroundContinuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered ‘aerosol-generating procedures’ in the treatment of COVID-19.ObjectiveTo measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients.Methods30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus.ResultsOverall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive.ConclusionsThe use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.

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SARS-CoV-2 environmental contamination from hospitalised COVID-19 patients receiving aerosol generating procedures

10.1101/2021.07.04.21259945 ◽

2021 ◽

Author(s):

Rebecca Winslow ◽

Jie Zhou ◽

E F Windle ◽

I X Nur ◽

Ranjit Lall ◽

...

Keyword(s):

Environmental Contamination ◽

Supplemental Oxygen ◽

Nasopharyngeal Swab ◽

Clinical Environment ◽

Surface Samples ◽

Hospitalised Patients ◽

Group A ◽

Potential Risks ◽

Fraction Of Inspired Oxygen ◽

Study Participants

ABSTRACT Background. Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered "aerosol-generating procedures" (AGPs) in the treatment of COVID-19. We aimed to measure air and surface environmental contamination of SARS-CoV-2 virus when CPAP and HFNO were used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients. Methods. 30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturations ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. RT qPCR analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus. Results. Overall 21/30 (70%) of participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination. Only one nasopharyngeal sample was culture positive. Conclusions. The use of CPAP and HFNO to treat moderate/severe COVID-19 was not associated with significantly higher levels of air or surface viral contamination in the immediate care environment.

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Detection of SARS-CoV-2 from patient fecal samples by whole genome sequencing

Gut Pathogens ◽

10.1186/s13099-021-00398-5 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Andreas Papoutsis ◽

Thomas Borody ◽

Siba Dolai ◽

Jordan Daniels ◽

Skylar Steinberg ◽

...

Keyword(s):

Next Generation Sequencing ◽

Nasopharyngeal Swab ◽

Whole Genome ◽

Rt Pcr ◽

Whole Genome Analysis ◽

Fecal Samples ◽

Oral Transmission ◽

Study Participants ◽

Next Generation Sequencing Ngs ◽

Generation Sequencing

Abstract Background SARS-CoV-2 has been detected not only in respiratory secretions, but also in stool collections. Here were sought to identify SARS-CoV-2 by enrichment next-generation sequencing (NGS) from fecal samples, and to utilize whole genome analysis to characterize SARS-CoV-2 mutational variations in COVID-19 patients. Results Study participants underwent testing for SARS-CoV-2 from fecal samples by whole genome enrichment NGS (n = 14), and RT-PCR nasopharyngeal swab analysis (n = 12). The concordance of SARS-CoV-2 detection by enrichment NGS from stools with RT-PCR nasopharyngeal analysis was 100%. Unique variants were identified in four patients, with a total of 33 different mutations among those in which SARS-CoV-2 was detected by whole genome enrichment NGS. Conclusion These results highlight the potential viability of SARS-CoV-2 in feces, its ongoing mutational accumulation, and its possible role in fecal–oral transmission. This study also elucidates the advantages of SARS-CoV-2 enrichment NGS, which may be a key methodology to document complete viral eradication. Trial registration ClinicalTrials.gov, NCT04359836, Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359836?term=NCT04359836&draw=2&rank=1).

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Robust Saliva-Based RNA Extraction-Free One-Step Nucleic Acid Amplification Test for Mass SARS-CoV-2 Monitoring

Molecules ◽

10.3390/molecules26216617 ◽

2021 ◽

Vol 26 (21) ◽

pp. 6617

Author(s):

Eva Rajh ◽

Tina Šket ◽

Arne Praznik ◽

Petra Sušjan ◽

Alenka Šmid ◽

...

Keyword(s):

Oral Cavity ◽

Reverse Transcription ◽

Screening Program ◽

Quantitative Polymerase Chain Reaction ◽

Rna Extraction ◽

Diagnostic Sensitivity ◽

Nucleic Acid Amplification ◽

Nasopharyngeal Swab ◽

Viral Spread ◽

One Step

Early diagnosis with rapid detection of the virus plays a key role in preventing the spread of infection and in treating patients effectively. In order to address the need for a straightforward detection of SARS-CoV-2 infection and assessment of viral spread, we developed rapid, sensitive, extraction-free one-step reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and reverse transcription loop-mediated isothermal amplification (RT-LAMP) tests for detecting SARS-CoV-2 in saliva. We analyzed over 700 matched pairs of saliva and nasopharyngeal swab (NSB) specimens from asymptomatic and symptomatic individuals. Saliva, as either an oral cavity swab or passive drool, was collected in an RNA stabilization buffer. The stabilized saliva specimens were heat-treated and directly analyzed without RNA extraction. The diagnostic sensitivity of saliva-based RT-qPCR was at least 95% in individuals with subclinical infection and outperformed RT-LAMP, which had at least 70% sensitivity when compared to NSBs analyzed with a clinical RT-qPCR test. The diagnostic sensitivity for passive drool saliva was higher than that of oral cavity swab specimens (95% and 87%, respectively). A rapid, sensitive one-step extraction-free RT-qPCR test for detecting SARS-CoV-2 in passive drool saliva is operationally simple and can be easily implemented using existing testing sites, thus allowing high-throughput, rapid, and repeated testing of large populations. Furthermore, saliva testing is adequate to detect individuals in an asymptomatic screening program and can help improve voluntary screening compliance for those individuals averse to various forms of nasal collections.

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Training of basic laparoscopic skills in surgical education

Lietuvos chirurgija ◽

10.15388/lietchirur.2013.4.2841 ◽

2013 ◽

Vol 12 (4) ◽

pp. 224-232

Author(s):

Gintaras Simutis ◽

Mantas Drungilas ◽

Pavel Petrik ◽

Eglė Petrik ◽

Virgilijus Beiša ◽

...

Keyword(s):

Surgical Education ◽

Practical Skills ◽

Laparoscopic Skills ◽

Cumulative Score ◽

Group A ◽

Group B ◽

Study Participants ◽

Navigation Experience ◽

Laparoscopic Experience ◽

Potential Use

Background / objectiveThe study was carried out to evaluate the potential use of laparoscopic simulators to enhance basic laparoscopic skills until proficiency is reached.Materials and methodsThe study participants were divided into two groups according to their experience in laparoscopic procedures: no prior experience (group A; n = 16) and laparoscope navigation experience (group B; n = 16). All the participants performed nineattempts of three basic laparoscopic skill tasks (“Instrument navigation”, “Cutting”, “Clip applying”) on the LapSim® simulator during three sessions within one month. The distribution of practice sessions was standardized by performing three attemptsfor each task per session and no more than one session per week. The assessment of laparoscopic skills was based on the cumulative score for each task measured by the computer system.ResultsTrainees in the group A were younger (22.2 ± 1.3 vs. 26.1 ± 1.3 years, P < 0.001). There were statistically significant differences in cumulative scores for all three tasks after the first five attempts between the two groups (P < 0.001). Comparison of thecumulative scores for the task “Instrument navigation” after the sixth attempt (P = 0.073), for the task “Clip applying” after the seventh attempt (P = 0.287), and for the task “Cutting” after the eighth attempt (P = 0.080) showed no significant differences among the study groups.ConclusionsThe results indicated that a group of trainees with no prior laparoscopic experience acquired the basic laparoscopic skills significantly faster. Proficiency in the laparoscopic basic tasks was achieved within 6–8 repetitions in both groups. These findings suggest that training of practical skills in using laparoscopic simulators should be integrated into medical education much earlier.Key words: surgical education, simulation, laparoscopy, virtual reality simulator, LapSimBazinių laparoskopinių įgūdžių įgijimas studijuojant mediciną TikslasAtlikti tyrimą, siekiant įvertinti kompiuterinių laparoskopinių simuliatorių naudojimą medicinos studijoms mokant pagrindinių laparoskopinių operacijų įgūdžių, kol bus įgyta reikiama patirtis.MetodikaTyrimo dalyviai pagal patirtį buvo suskirstyti į dvi grupes: vienos grupės tiriamieji neturėjo jokios išankstinės laparoskopinių operacijų patirties (A grupė, n=16), o kitos grupės turėjo tik navigacijos laparoskopu patirties (B grupė, n=16). Visi dalyviai pertrejas pratybas su laparoskopiniu virtualiu simuliatoriumi LapSim® atliko trijų pagrindinių laparoskopinių užduočių („Instrumentų navigacija“, „Pjovimas“, „Kabučių uždėjimas“) devynis bandymus. Kiekvieną užsiėmimą atskira užduotis buvo kartojamatris kartus, o užsiėmimas vyko ne dažniau nei kartą per savaitę. Vertintas galutinis užduoties rezultatas. Laparoskopinių operacijų įgūdžiai vertinti kompiuterine sistema pagal išvestinį kaupiamąjį kiekvienos užduoties balą.RezultataiA grupės dalyviai buvo jaunesni (22,2±1,3 vs. 26,1±1,3 metų, p<0,001). Išanalizavus visų trijų užduočių kaupiamuosius balus po pirmųjų penkių bandymų, abi grupės skyrėsi statistiškai reikšmingai (p<0,001). Tyrimą tęsiant ir lyginant išvestinį kaupiamąjįbalą atliekant užduotį „Instrumentų navigacija“ po šešto bandymo (p=0,073), užduotį „Kabučių uždėjimas“ po septinto bandymo (p=0,287), užduotį „Pjovimas“ po aštunto bandymo (p = 0,080), jokių reikšmingų skirtumų tarp tiriamų grupių nerasta.IšvadosTyrimo rezultatai parodė, kad net be laparoskopinių operacijų patirties tokių operacijų pagrindinius įgūdžius laparoskopiniu simuliatoriumi įgyjama greičiau. Chirurginės simuliacijos užduočių kartojimas iki 6–8 bandymų leidžia įgyti gerus pagrindiniųlaparoskopinių operacijų įgūdžius. Šie rezultatai rodo, kad praktinių įgūdžių mokymas naudojant laparoskopinį simuliatorių turėtų būti įtrauktas į medicinos studijų programą.Reikšminiai žodžiai: chirurgijos studijos, simuliacija, laparoskopija, virtualios realybės simuliatorius, LapSim.

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Duration of Infectious Virus Shedding in Patients With Severe Coronavirus Disease 2019 Who Required Mechanical Ventilation

10.21203/rs.3.rs-395009/v1 ◽

2021 ◽

Author(s):

Toshihito Nomura ◽

Hiroki Kitagawa ◽

Keitaro Omori ◽

Norifumi Shigemoto ◽

Masaki Kakimoto ◽

...

Keyword(s):

Mechanical Ventilation ◽

Symptom Onset ◽

Infectious Virus ◽

Quantitative Polymerase Chain Reaction ◽

University Hospital ◽

Nasopharyngeal Swab ◽

Test Results ◽

Virus Shedding ◽

Viral Culture ◽

Respiratory Management

Abstract Approximately 5% of patients with coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 develop severe COVID-19. Severe COVID-19 requires respiratory management with mechanical ventilation and an extended period of treatment. Prolonged infectious virus shedding is a concern in severe COVID-19 cases, but few reports have examined the duration of infectious virus shedding. Therefore, we investigated the duration of infectious virus shedding in patients transferred to Hiroshima University Hospital with severe COVID-19 requiring mechanical ventilation. Nasopharyngeal swab specimens were collected and analyzed using both viral culture and reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) tests between December 2020 and February 2021. Of the 23 patients tested, the proportions of those with positive test results at first specimen collection on RT-qPCR and viral culture tests were 95·7% and 30·4%, respectively. All six patients with positive viral culture test results who were followed-up tested negative 24 days after symptom onset but remained positive on RT-qPCR. The longest negative conversion time was observed in a dialysis patient on immunosuppressive drugs. This study indicated that patients with severe COVID-19 remain culture positive for ≥ 10 days after symptom onset. Additionally, immunosuppressed patients with severe COVID-19 could consider isolation for ≥ 20 days.

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Calling in sick: impacts of fever on intra-urban human mobility

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2016.0390 ◽

2016 ◽

Vol 283 (1834) ◽

pp. 20160390 ◽

Cited By ~ 16

Author(s):

T. Alex Perkins ◽

Valerie A. Paz-Soldan ◽

Steven T. Stoddard ◽

Amy C. Morrison ◽

Brett M. Forshey ◽

...

Keyword(s):

Human Mobility ◽

Structured Interview ◽

Pathogen Transmission ◽

Contact Network ◽

Control Group ◽

Common Disease ◽

Nested Models ◽

Host Mobility ◽

Group A ◽

Study Participants

Pathogens inflict a wide variety of disease manifestations on their hosts, yet the impacts of disease on the behaviour of infected hosts are rarely studied empirically and are seldom accounted for in mathematical models of transmission dynamics. We explored the potential impacts of one of the most common disease manifestations, fever, on a key determinant of pathogen transmission, host mobility, in residents of the Amazonian city of Iquitos, Peru. We did so by comparing two groups of febrile individuals (dengue-positive and dengue-negative) with an afebrile control group. A retrospective, semi-structured interview allowed us to quantify multiple aspects of mobility during the two-week period preceding each interview. We fitted nested models of each aspect of mobility to data from interviews and compared models using likelihood ratio tests to determine whether there were statistically distinguishable differences in mobility attributable to fever or its aetiology. Compared with afebrile individuals, febrile study participants spent more time at home, visited fewer locations, and, in some cases, visited locations closer to home and spent less time at certain types of locations. These multifaceted impacts are consistent with the possibility that disease-mediated changes in host mobility generate dynamic and complex changes in host contact network structure.

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Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-317148 ◽

2019 ◽

Vol 105 (4) ◽

pp. 399-404 ◽

Cited By ~ 1

Author(s):

Erik A Jensen ◽

Huayan Zhang ◽

Rui Feng ◽

Kevin Dysart ◽

Kathleen Nilan ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Random Order ◽

Supplemental Oxygen ◽

Very Preterm Infants ◽

Intention To Treat ◽

Postmenstrual Age ◽

Registration Number ◽

Adjusted Incidence Rate ◽

Fraction Of Inspired Oxygen ◽

Gastric Feeding

ObjectiveCompare rates of hypoxaemia during transpyloric and gastric feedings in very preterm infants with severe bronchopulmonary dysplasia.DesignN-of-1 multiple crossover trials with individual patient and pooled data analyses.SettingLevel IV intensive care nursery.PatientsInfants receiving positive airway pressure between 36 and 55 weeks postmenstrual age were enrolled between December 2014–July 2016.InterventionN-of-1 trial consisting of two blocks, each with a 4-day gastric and 4-day transpyloric feeding period assigned in random order.Main outcome measuresThe primary outcome was the frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10–180 s). Secondary outcomes included the daily proportion of time with an SpO2 ≤80% and mean daily fraction of inspired oxygen.ResultsOf 15 infants, 13 completed the trial and 2 stopped early for transient worsening in respiratory status during gastric feedings. In the intention-to-treat analyses, transpyloric feedings resulted in increased rates of intermittent hypoxaemia in five infants, greater time per day in hypoxaemia in three infants and more supplemental oxygen use in three infants. One infant received more supplemental oxygen during gastric feedings. The remaining study outcomes were similar between the feeding routes in all other infants. Pooling all data, transpyloric feedings resulted in a higher frequency of intermittent hypoxaemic events (median 7.5/day (IQR 1–23.5) vs 3/day (1–11); adjusted incidence rate ratio 1.8, 95% CI 1.3 to 2.5) and a greater proportion of daily hypoxaemia time (median 0.8% (IQR 0.1–2.3) vs 0.4% (0.07–1.8); adjusted mean difference 1.6, 95% CI 1.1 to 2.5).ConclusionsTranspyloric compared with gastric feedings modestly increased rates of hypoxaemia among study participants.Trial registration numberNCT02142621

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The neglected element of hand hygiene - significance of hand drying, efficiency of different methods and clinical implication: A review

Journal of Infection Prevention ◽

10.1177/1757177418815549 ◽

2018 ◽

Vol 20 (2) ◽

pp. 66-74 ◽

Cited By ~ 4

Author(s):

John Gammon ◽

Julian Hunt

Keyword(s):

Hand Hygiene ◽

Environmental Contamination ◽

Environmental Sustainability ◽

Critical Factor ◽

Drying Methods ◽

Clinical Environment ◽

Occupational Contact Dermatitis ◽

Drying Efficiency ◽

The Impact ◽

Hand Drying

Hand hygiene is a fundamental strategy for controlling the spread of infection. Careful hand drying is integral to the process of hand hygiene, which aims to optimise the removal of potentially pathogenic microorganisms. Ineffective hand drying results in wet hands that are an infection risk increasing the potential for cross-infection, occupational contact dermatitis for healthcare practitioners, harm to patients and environmental contamination. Evidence indicates that there has been limited research regarding the significance of hand drying and the efficacy and clinical impact of different drying methods. The purpose of this review paper was to scope and evaluate the existing literature pertaining to hand drying; to examine the clinical consequences associated with wet hands for patients, healthcare practitioners and the clinical environment; to assess the efficacy of different drying methods; to consider the impact on patient safety; and to progress the research, debate and practice relating to hand drying. The methodological framework applied in this review was that of Arksey and O’Malley (2007). Twenty-one papers identified from 112 abstracts screened were included in the review. Analysis identified three primary themes emerging from the literature: (1) efficacy of hand drying methods; (2) drying method and microbial translocation, dispersion and environmental contamination; and (3) drying methods and environmental sustainability. This review highlights the equal importance of hand drying in the process of hand hygiene and suggests that the efficacy of hand drying is a critical factor in the prevention of the transfer of microorganisms to the environment, and from person to person following hand washing. In conclusion, this paper argues that greater attention needs to be given to hand drying in terms of practice, policy and research and its importance in clinical settings given greater focus.

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Viral Load Dynamics in Sputum and Nasopharyngeal Swab in Patients with COVID-19

Journal of Dental Research ◽

10.1177/0022034520946251 ◽

2020 ◽

Vol 99 (11) ◽

pp. 1239-1244 ◽

Cited By ~ 3

Author(s):

R. Liu ◽

S. Yi ◽

J. Zhang ◽

Z. Lv ◽

C. Zhu ◽

...

Keyword(s):

Viral Load ◽

Quantitative Polymerase Chain Reaction ◽

Nasopharyngeal Swab ◽

Chain Reaction ◽

Global Pandemic ◽

Observational Cohort ◽

Polymerase Chain ◽

Underlying Diseases ◽

Temporal Profiles ◽

Substantial Morbidity

Coronavirus disease 2019 (COVID-19) has caused a global pandemic associated with substantial morbidity and mortality. Nasopharyngeal swabs and sputum samples are generally collected for serial viral load screening of respiratory contagions, but temporal profiles of these samples are not completely clear in patients with COVID-19. We performed an observational cohort study at Renmin Hospital of Wuhan University, which involved 31 patients with confirmed COVID-19 with or without underlying diseases. We obtained samples from each patient, and serial viral load was measured by real-time quantitative polymerase chain reaction. We found that the viral load in the sputum was inclined to be higher than samples obtained from the nasopharyngeal swab at disease presentation. Moreover, the viral load in the sputum decreased more slowly over time than in the nasopharyngeal group as the disease progressed. Interestingly, even when samples in the nasopharyngeal swab turned negative, it was commonly observed that patients with underlying diseases, especially hypertension and diabetes, remained positive for COVID-19 and required a longer period for the sputum samples to turn negative. These combined findings emphasize the importance of tracking sputum samples even in patients with negative tests from nasopharyngeal swabs, especially for those with underlying conditions. In conclusion, this work reinforces the importance of sputum samples for SARS-CoV-2 detection to minimize transmission of COVID-19 within the community.

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Evaluation of Knowledge of Oxygen Therapy and Reading of Flowmeter among the Health Workers in the Pediatric Unit of the Hospital Universitario San Ignacio, Bogotá, Colombia

Universitas Médica ◽

10.11144/javeriana.umed59-3.oxig ◽

2018 ◽

Vol 59 (3) ◽

pp. 1-8

Author(s):

Elly Morros González ◽

Diana Estrada Cano ◽

Marcela Murillo Galvis ◽

Jos Carlos Montes Correa ◽

Nelcy Rodríguez Malagón ◽

...

Keyword(s):

Adverse Effects ◽

Oxygen Saturation ◽

Oxygen Therapy ◽

Health Workers ◽

Supplemental Oxygen ◽

Cross Sectional Study ◽

Peripheral Oxygen Saturation ◽

Cross Sectional ◽

Fraction Of Inspired Oxygen ◽

Supplemental Oxygen Therapy

Introduction: Supplemental oxygen is considered a pharmaceutical drug; therefore, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and the peripheral oxygen saturation (SpO2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpO2 goals and reading of oxygen flowmeters among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied survey between December 2016 and January 2017. The poll evaluated topics on supplemental oxygen therapy fundamentals and adverse effects, SpO2 goals and flowmeter readings through flowmeters photographs indicating a specific fraction of inspired oxygen (FiO2). Results: The response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% of participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplemental oxygen concentration greater than required. In neonatal population, 10% considered oxygen saturation goals equal to or greater than 96%. In the flowmeter’s reading evaluation, incorrect answers ranged from 9 to 19%. Conclusion: It is imperative to reinforce updated concepts on oxygen therapy, with emphasis in SpO2 goals, adverse effects and appropriate flowmeter’s readings through periodic educational campaigns.

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