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1.
Modern Pathology ; 35(SUPPL 2):20, 2022.
Article in English | EMBASE | ID: covidwho-1857840

ABSTRACT

Background: While all autopsies pose a potential risk of exposure to infectious agents, the recent emerging SARS-CoV-2 (COVID) pandemic reminds us of this elevated potential. During this outbreak there are still few detailed protocol recommendations, limited data, and much uncertainty about how exactly to handle such a case. Furthermore, it has been estimated that SARS-CoV-2 autopsies take at least three times longer than a standard autopsy. We designed an institutional autopsy protocol to mitigate occupational risk, increase efficiency, limit exposure, and maximize educational value. Design: The personal protective equipment (PPE) for the evisceration component of the autopsy consisted of Powered Air Purifying Respirator (PAPR), two layers of long cuff disposal gloves, plastic apron, fluid proof gown, and fluid resistant leg covers. All SARS-CoV-2 autopsies were conducted by a limited number of trained personnel including an attending pathologist, resident and pathologist assistant using the Virchow evisceration method. The cranium was opened using a bone saw with an integrated vacuum. Organ retrieval, weight, and photographing of the cut surface were performed on the day of evisceration and could be completed within one hour, including cleaning of the autopsy suite. Sectioning was performed after fixation for 48-72 hours in 10% neutral buffered formalin. On the day of sectioning, a PAPR was replaced with a N95 respirator. Results: Over 10 members of our department have contributed to performing 40 COVID autopsies since 2019. No personnel became infected with SARS-CoV-2. Our complete protocol has provided our institution with resources to further study the pathogenesis of COVID in humans. It also differs from other modifications by for example, having multiple body cavities open at a time and not having autopsy rooms dedicated only to infected cadavers. Using these methods we have been able to supply numerous institutional labs with organ sections for various research protocols. Conclusions: Although post-mortem examination of COVID-infected decedents has inherent risk, only complete autopsies are a source of invaluable and irreplaceable information. This protocol was originally designed for SARS-CoV-2, but we recognize the potential application for other high-risk infectious cases. It is our hope that as more practical evidence-based biosafety guidance is disseminated the need for limited autopsies and partially or completely suspended autopsy services will be obviated.

2.
Clinical Nurse Specialist ; 36(2):84-91, 2022.
Article in English | Web of Science | ID: covidwho-1794981

ABSTRACT

Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.

3.
Addressing Disaster Vulnerability among Homeless Populations during COVID-19 ; : 1-28, 2021.
Article in English | Scopus | ID: covidwho-1737460

ABSTRACT

During the COVID-19 pandemic, disruptions to key services for populations experiencing homelessness may lead to secondary effects in the context of a disaster, including effects on health and safety, which require additional population-specific support. Reducing disaster vulnerability for people experiencing homelessness during the COVID-19 pandemic requires adapting existing preparedness guidance to an evolving situation. Addressing Disaster Vulnerability among Homeless Populations during COVID-19 reviews research on disaster vulnerability, homelessness, the pandemic, and intersecting hazards and disasters. This rapid expert consultation includes considerations for alternative shelter facilities for homeless populations during a disaster;suggestions on how to navigate service reductions and support population-specific needs;and guidance for supporting populations experiencing homelessness in the aftermath of disasters. © National Academy of Sciences. All rights reserved.

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