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Infect Prev Pract ; 3(4): 100170, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1446728


BACKGROUND: As researchers race to understand the nature of COVID-19 transmission, healthcare institutions must treat COVID-19 patients while also safeguarding the health of staff and other patients. One aspect of this process involves mitigating aerosol transmission of the SARS-CoV2 virus. The U.S. Centers for Disease Control and Prevention (CDC) provides general guidance on airborne contaminant removal, but directly measuring aerosol clearance in clinical rooms provides empirical evidence to guide clinical procedure. AIM: We present a risk-assessment approach to empirically measuring and certifying the aerosol clearance time (ACT) in operating and procedure rooms to improve hospital efficiency while also mitigating the risk of nosocomial infection. METHODS: Rooms were clustered based on physical and procedural parameters. Sample rooms from each cluster were randomly selected and tested by challenging the room with aerosol and monitoring aerosolized particle concentration until 99.9% clearance was achieved. Data quality was analysed and aerosol clearance times for each cluster were determined. FINDINGS: Of the 521 operating and procedure rooms considered, 449 (86%) were issued a decrease in clearance time relative to CDC guidance, 32 (6%) had their clearance times increased, and 40 (8%) remained at guidance. The average clearance time change of all rooms assessed was a net reduction of 27.8%. CONCLUSION: The process described here balances the need for high-quality, repeatable data with the burden of testing in a functioning clinical setting. Implementation of this approach resulted in a reduction in clearance times for most clinical rooms, thereby improving hospital efficiency while also safeguarding patients and staff.

Am J Transplant ; 21(8): 2890-2894, 2021 08.
Article in English | MEDLINE | ID: covidwho-1297494


Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies.

COVID-19 , Liver Failure, Acute , Liver Transplantation , Adolescent , Female , Humans , Liver Failure, Acute/etiology , Liver Failure, Acute/surgery , Liver Transplantation/adverse effects , Pandemics , Polymerase Chain Reaction , SARS-CoV-2