Preoperative Fear, Operative Gear, and Postoperative Care, in Tracheostomy during Covid Times – Our Experience at a Tertiary Care Hospital

BACKGROUND The SARS-CoV-2 is known to be highly contagious from respiratory tract droplets and aerosol exposure. ENT surgeons deal with the upper airway and are exposed to aerosol generating procedures on a daily basis. Aerosol generating procedure such as tracheostomy is necessary in patients with head and neck cancers having airway obstruction. METHODS We share our experience of 38 cases where we had to perform tracheostomy during these Covid times under various circumstances in a tertiary care centre with a dedicated Covid Isolation centre for 5 districts with 210 beds reserved for Covid patients. RESULTS All 38 tracheostomies were performed successfully following the guidelines formulated by our team, with proper precautions not a single team member got infected with Covid-19. No test is 100 % sensitive, so all precautions must be taken while dealing with every patient and PPEs should be used in all tracheostomies. CONCLUSIONS No test is 100 % sensitive, so all precautions must be taken while dealing with every patient and PPEs should be used in all tracheostomies. Our policy of anticipating tracheostomy in patients with impending stridor helped us reduce the risk of having to perform emergency tracheostomies with Covid status unknown. KEY WORDS Aerosol, COVID-19, PPE - Kit, SARS-CoV-2, Stridor, Tracheostomy

Implementing a Negative Pressure Isolation Space within a Skilled Nursing Facility to Control SARS-CoV-2 Transmission

Background: Isolation space must be expanded during pandemics involving airborne transmission. Little to no work has been done to establish optimal design strategies and implementation plans to ease surge capacity and expand isolation capacity over long periods in congregate living facilities. The COVID-19 pandemic has an airborne transmission component and requires isolation, which is difficult to accomplish in skilled nursing facilities. Purpose: In this study we designed, implemented, and validated an isolation space at a skilled nursing facility in Lancaster, PA. The overall goal was to minimize disease transmission between residents and staff within the facility. Basic Procedures: We created an isolation space by modifying an existing HVAC system of the SNF. We measured pressure on-site and performed computational fluid dynamics and Lagrangian particle-based modeling to test containment and possible transmission extent given the isolation space is considered negative rather than individual rooms. Main Findings: Pressure data shows the isolation space maintained an average hourly value of (standard deviation) -2.3 Pa (0.12 Pa) pressure differential between it and the external hallway connected to the rest of the facility. No transmission of SARS-CoV-2 between residents isolated to the space occurred, nor did any transmission to the staff or other residents occur. The isolation space was successfully implemented and, as of writing, continues to be operational through the pandemic. Key Words: aerosol transmission, airborne transmission, surge capacity, engineering controls, congregate living facilities