Severe Acute Respiratory Syndrome Coronavirus 2 Surveillance and Exposure in the Perioperative Setting With Universal Testing and Personal Protective Equipment Policies.
Severe Acute Respiratory Syndrome Coronavirus 2 Surveillance and Exposure in the Perioperative Setting With Universal Testing and Personal Protective Equipment Policies.
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DOI：
10.1093/cid/ciaa1607
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发表时间：
2021-11-02
期刊：
影响因子：
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通讯作者：
Kamboj, Mini
中科院分区：
文献类型：
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作者：
Aslam, Anoshe;Singh, Jessica;Kamboj, Mini
背景：纽约市（NYC）于二零二零年三月及四月经历2019冠状病毒病（COVID-19）病例激增。从那时起，基于通用聚合酶链反应（PCR）的监测检测和个人防护设备（PPE）措施在程序设置中得到广泛使用。在社区COVID-19发病率不断下降和持续较低的地区，基于PCR的监测检测的实用性和可持续性的已发表经验有限。方法：本研究于2020年3月22日至8月22日在纽约市的一家三级癌症护理中心进行。无症状患者在手术、介入放射学程序和内窥镜检查前接受严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测。如果患者在手术后48小时内重新检测呈阳性，则在手术区域进行接触追踪。结果：从2020年3月22日至8月22日，11540名独特患者在纪念斯隆凯特琳癌症中心进行手术或手术前进行了14233次检测。总体来看，65例患者呈阳性，阳性率最高时为4.3%，2020年4月后降至0.3%以下。在65例阳性病例中，3例为症状前期，38例为无症状。在无症状检测阳性患者中，76%在首次检测时PCR循环阈值>30。5例患者在术后即刻检测为新阳性，暴露82名员工，其中1例可能传播（1.2%）。结论：在我们的研究中，在手术前监测中确定的SARS-CoV-2感染的患病率较低，该研究是在研究后期社区传播有限的地区进行的。通用PPE在手术环境中具有保护作用。需要最佳和灵活的诊断策略来实现和维持全面的术前监测检测的目标。
BACKGROUND: New York City (NYC) experienced a surge of coronavirus disease 2019 (COVID-19) cases in March and April 2020. Since then, universal polymerase chain reaction (PCR)-based surveillance testing and personal protective equipment (PPE) measures are in wide use in procedural settings. There is limited published experience on the utility and sustainability of PCR-based surveillance testing in areas with receding and consistently low community COVID-19 rates.METHODS: The study was conducted at a tertiary care cancer center in NYC from 22 March to 22 August 2020. Asymptomatic patients underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing before surgeries, interventional radiology procedures, and endoscopy. Contact tracing in procedural areas was done if a patient with an initial negative screen retested positive within 48 hours of the procedure.RESULTS: From March 22 until August 22, 2020, 11 540 unique patients underwent 14 233 tests before surgeries or procedures at Memorial Sloan Kettering Cancer Center. Overall, 65 patients were positive, with a peak rate of 4.3% that fell below 0.3% after April 2020. Among the 65 positive cases, 3 were presymptomatic and 38 were asymptomatic. Among asymptomatic test-positive patients, 76% had PCR cycle threshold >30 at first detection. Five patients tested newly positive in the immediate postoperative period, exposing 82 employees with 1 case of probable transmission (1.2%).CONCLUSIONS: The prevalence of SARS-CoV-2 infection identified on preprocedural surveillance was low in our study, which was conducted in an area with limited community spread at the later stage of the study. Universal PPE is protective in procedural settings. Optimal and flexible diagnostic strategies are needed to accomplish and sustain the goals of comprehensive preprocedure surveillance testing.