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1.
Otolaryngol Head Neck Surg ; 163(4): 695-698, 2020 10.
Article in English | MEDLINE | ID: covidwho-999411

ABSTRACT

Patients with a laryngectomy are at increased risk for droplet-transmitted diseases and, therefore, COVID-19, which has now caused a worldwide pandemic. Adaptive measures to protect patients with a laryngectomy and their families were designed and implemented in the Hong Kong SAR (HK). Driven by the fear of severe acute respiratory syndrome in 2003, hospitals in HK have since modified infection control routines to prevent a repeat public health nightmare. To face COVID-19, caused by SARS-CoV-2, we have adapted guidelines for our patients with a laryngectomy. Contact precautions, droplet precautions with physical barriers, and hand and equipment hygiene are our mainstays of prevention against COVID-19, and sharing these routines is the aim of this article. The COVID-19 pandemic is still roaring ahead. Awareness and precautions for patients with a laryngectomy who may be at higher risk are outlined here and should be maintained during the current pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Management , Disease Transmission, Infectious/prevention & control , Head and Neck Neoplasms/surgery , Laryngectomy , Pneumonia, Viral/epidemiology , COVID-19 , Comorbidity , Coronavirus Infections/transmission , Head and Neck Neoplasms/epidemiology , Humans , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2
2.
Otolaryngol Head Neck Surg ; 164(6): 1136-1147, 2021 06.
Article in English | MEDLINE | ID: covidwho-901656

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.


Subject(s)
COVID-19/prevention & control , Infection Control , Internationality , Perioperative Care , Tracheostomy , COVID-19/epidemiology , COVID-19/transmission , Clinical Protocols , Humans , Practice Patterns, Physicians'
3.
Head Neck ; 42(7): 1454-1459, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-216116

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) pandemic has been spreading worldwide at an alarming rate. Health-care workers have been confronted with the challenge of not only treating patients with the virus, but also managing the disruption of health-care services caused by COVID-19. In anticipation of outbreak, clinic sessions and operation theater lists have been actively cut back since February 2020 to reduce hospital admissions and clinic attendances. This has severely disrupted health-care services, leading to accumulating clinic caseload and substantial delays for operations. The head and neck cancer service has been faced with the difficult task of managing the balance between infection risk to health-care providers and the risk of disease progression from prolonged waiting times. We share our experience in Hong Kong on the mitigation of head and neck cancer service disruption through telehealth and multi-institution collaboration.


Subject(s)
Coronavirus Infections/epidemiology , Elective Surgical Procedures/statistics & numerical data , Otolaryngology/organization & administration , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , COVID-19 , Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Female , Hong Kong , Humans , Infection Control/organization & administration , Interdisciplinary Communication , Interprofessional Relations , Male , Operating Rooms/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Assessment , Surgical Oncology/organization & administration
4.
Head Neck ; 42(6): 1235-1239, 2020 06.
Article in English | MEDLINE | ID: covidwho-66374

ABSTRACT

Head and neck examinations are commonly performed by all physicians. In the era of the COVID-19 pandemic caused by the SARS-CoV-2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Based on experience and evidence from SARS-CoV-1 and early experience with SARS-CoV-2, we provide our perspective and guidance on mitigating transmission risk during head and neck examination, upper airway endoscopy, and head and neck mucosal surgery including tracheostomy.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Diagnostic Tests, Routine/standards , Disease Transmission, Infectious/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , COVID-19 , Coronavirus Infections/epidemiology , Female , Global Health , Head/physiopathology , Humans , Male , Neck/physiopathology , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Physical Examination/standards , Pneumonia, Viral/epidemiology
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