Practical application of Standard Operating Procedures (SOP) Guidelines for COVID-19 autopsies: an Italian experience

Introduction: SARS-CoV-2, responsible for severe human infection with high mortality rate, has been classified as HG3 pathogen. Despite the need to perform autopsy to clarify the pathogenesis of COVID, such procedures are at high risk of contagion due to the direct contact with aerosols and body fluids. To ensure the safety of the personnel against contagion, it is mandatory to follow the SOP for the management of autopsy environment and infected body. Several studies have shown that SARS-CoV-2 persists on inanimate surfaces for a long time and is also ubiquitously detected in many human tissues, even after long time after death. Material and Methods: Many international scientific societies have drowned up various guidelines on biosafety and exposure precautions, but none of these is uniquely adopted. So, in the daily practice our greatest difficulty was to identify SOP adherent to the guidelines but applicable to our reality. In our experience, COVID autopsies were performed accordingly to the following SOP: - COVID mortuary refrigerators - BSL3 autopsy facility - Autopsy saw with aspiration system - PPE: surgical scrub, rubber medical shoes, coverall, shoe leggings, FFP3 mask, waterproof gown or apron, eyes protection, two pairs of medical gloves and one of cut-resistant gloves - Sanitization of surgical tools in autoclave - Sanitization of the environments with VHP - Periodic nasopharyngeal swabs from personnel Results and Conclusions: Our work aims to share our experience and to demonstrate that adopting these measures is effective in reducing risk of infection. In fact, the periodic COVID swabs were negative in 100% of cases.

Accuracy of Impression Material During COVID-19 after Sterilization-In vitro Study

Aims: The goal of this research is to assess the effect of steam autoclave sterilization due to the impact of Covid-19 on the accuracy of the elastomer impression materials. Study Design: In vitro study. Place and Duration of Study: Department of oral and Maxillofacial Prosthodontics, King Abdul-Aziz University, Jeddah;Saudi Arabia, between June 2021 and November 2021. Methodology: The following materials were used in this study: fully dentate master cast, metal trays, elastomer impression material (addition silicon), type IV stone. Forte impressions made using the metal tray and elastomer impression materials. The impressions were separated equally into two groups: Control group (C.G), untreated impressions. Sterilized group (S.G): Impressions were sterilized by using the steam autoclave. To make stone castings for each group, they were poured with type IV stone. The traveling microscope was used to evaluate the impression material's dimensional accuracy and detail reproduction with and without autoclave sterilization. Results: The cross-arch distance (X) of the master model was measured (41.29 mm), While the cross arch distance (X) in the control group (C.G) of the untreated impressions had a mean and standard deviation of 41.492 +/- 0.150 mm. In the tested group (S.G) : the sterilized impression, we found the cross-arch distance (X) had a mean and standard deviation of 41.628 +/- 0.223 mm. The master model's Anteroposterior distance (A-P) was measured (21.12 mm). For the control group (C.G) : we found the mean and standard deviation value reading of the A-P distance were 20.899 +/- 0.79 mm. For (S.G) group: we found the mean and standard deviation reading of the A-P distance were 19.992 +/- 0.482 mm. Conclusion: Steam autoclave sterilization of the elastomer impression material should be considered carefully, especially when fabricating fixed partial dentures. If the impression material is to be used in making diagnostic castings, conventional steam autoclave sterilization of the elastomers impression material may be sufficient for patients.

Sterilization of gowns: making the most of a scarce commodity during the COVID-19 pandemic.

Baylor Clinic in Mbabane, Eswatini, convened a crisis meeting to tackle critical shortages of long-sleeved disposable gowns that resulted from COVID-19 pandemic constraints on available personal protective equipment (PPE). A strategy deemed safe, affordable and sustainable was adopted to autoclave and re-use gowns based on a risk-stratified approach. Key objectives were to ensure essential infection control and prevention (ICP) for medical doctors, nurses, and laboratory teams. Administrative, environmental and personal protective measures for ICP were enhanced through regular staff training. This strategy for gown re-use has been invaluable in motivating responsible stewardship and maximization of available gowns during the COVID-19 pandemic.

La Baylor Clinic de Mbabane, Eswatini, a convoqué une réunion de crise pour remédier à la grave pénurie de blouses jetables à manches longues due au manque d'équipements de protection individuelle (PPE) lié à la pandémie de COVID-19. Une stratégie jugée sûre, abordable et durable a été adoptée pour stériliser par autoclave et réutiliser les blouses en prenant appui sur une approche stratifiée des risques. Les objectifs clés étaient de garantir la prévention et le contrôle des infections (ICP) pour les médecins, les infirmiers et les équipes de laboratoire. Les mesures ICP d'ordre administratif, environnemental et de protection individuelle ont été renforcées par le biais de formations régulières du personnel. Cette stratégie de réutilisation des blouses a permis de promouvoir une gestion responsable et de tirer au maximum profit des blouses disponibles pendant la pandémie de COVID-19.

Gadgets and Armamentarium of Maxillofacial Surgeons during Coronavirus Pandemic.

INTRODUCTION: We all know about the grave situation caused by the novel coronavirus in recent times. Although the maxillofacial surgeons are not at forefront of dealing with the coronavirus directly, they are at increased risk due to their working area on face, mouth, and oral cavity. There is an urgent need to upgrade the already set guidelines and follow them stringently. Any procedure done within the oral cavity is a high-risk procedure and this upgradation is necessary because present means are insufficient to prevent infection from this deadly virus. This article aims to review and discuss all the new gadgets and armamentarium required to deal with patients during and post coronavirus pandemic. MATERIALS AND METHODS: The authors performed a thorough literature search on various armamentarium and new gadgets introduced into the field of dentistry during the coronavirus pandemic worldwide. The relevant armamentarium is discussed under three broad headings, namely, those required before, during and after the procedures for easy understanding. RESULTS: A total of 15 gadgets and armamentarium related to oral and maxillofacial surgical practice are named and discussed in the literature review. DISCUSSION: We are particularly vulnerable to the transmission of diseases easily both due to the field of interest of work and type of instrumentation. Thus, we need to be extremely cautious about the procedure. Since, the literature is scarce about the sequelae of the coronavirus disease; shift to the automated, contactless gadgets is the way to look forward to a healthy dental practice. CONCLUSION: These gadgets are user friendly for any small dental set-up as well. The choice of these upgraded instruments are prerogative of the individual professionals according to their exclusive practice. Yet, the authors encourage all health care professionals to focus on better training in infection control and cross-contamination.

Multicycle Autoclave Decontamination of N95 Filtering Facepiece Respirators.

Introduction: During pandemic situations like the one caused by the emergent coronavirus SARS-CoV-2, healthcare systems face the challenge of limited personal protective equipment and impaired supply chains. This problem poses a threat to healthcare workers, first responders, and the public, which demands solutions that can span the gap between institutional shortages and resupplies. Objectives: To examine the efficacy of autoclave-based decontamination for the reuse of single-use surgical masks and N95 filtering facepiece respirators (FFRs). This method is the most readily available form of decontamination in the hospital and laboratory settings. Methods: Three models of N95 FFRs and two procedural masks were evaluated in this study. A moist heat autoclave using four different autoclave cycles: 115°C for one hour, 121.1°C for 30 minutes, 130°C for two minutes, and 130°C for four minutes was used. After the autoclave process, the FFRs were NIOSH fit tested and particle counting was performed for both coarse particles of 5 micrometers (µM) and fine particles from 0.1µM to 1.0µM. Results: We observed negligible alterations in the functionality and integrity of 3M 1805 and 3M 1870/1870+ N95 FFRs after three autoclave cycles. Surgical masks also showed minimal changes in functionality and integrity. The 3M 1860 FFR failed fit test after a single autoclave decontamination cycle. Discussion and Conclusion: The study finds that specific surgical masks and N95 FFR models can withstand autoclave decontamination for up to three cycles. Additionally, the autoclave cycles tested were those that could be readily achieved by both clinical and research institutions.