ABSTRACT
Background and purpose: : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods: Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results: Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion: Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
ABSTRACT
Background and purpose : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
ABSTRACT
No guidance exists on how to safely perform modified barium swallows (MBS) in the midst of the COVID-19 pandemic or other communicable airborne respiratory infections (C-ARI). MBS has the potential to become an aerosol generating procedure (AGP) as it may trigger a cough or necessitate suctioning which may result in transmission of C-ARI putting patients and health care workers at risk. Regulations and best practices from international and US governmental and commercial agencies were reviewed. This review led to the multidisciplinary development of best practices of the safety measures and structural requirements to avoid transmission of SARS-CoV-2 or other C-ARIs when performing MBS. Implementation of these best practices resulted in structural changes to the fluoroscopy suite and protocol workflows. This enabled patients with COVID-19 to undergo MBS while maintaining patient and staff safety including mitigation of potential risk of onward transmission of SARS-CoV-2 to other patients. With proper modifications, MBS can be safely performed on patients with C-ARI such as COVID-19 while maintaining patient and health care worker (HCW) safety.