Covid-19 Transmission to Health Care Personnel During Tracheostomy Under a Multidisciplinary Safety Protocol

Taylor C. Standiford, MD; Janice L. Farlow, MD, PhD; Michael J. Brenner, MD; Ross Blank, MD; Venkatakrishna Rajajee, MBBS; Noel R. Baldwin, BSN, RN; Steven B. Chinn, MD, MPH; Jessica A. Cusac, MA, RRT, ACCS; Jose De Cardenas, MD; Kelly M. Malloy, MD; Kelli L. McDonough, MS; Lena M. Napolitano, MD; Michael W. Sjoding, MD; Emily K. Stoneman, MD; Laraine L. Washer, MD; Pauline K. Park, MD


Am J Crit Care. 2022;31(6):452-460. 

In This Article

Abstract and Introduction


Background: Tracheostomies are highly aerosolizing procedures yet are often indicated in patients with COVID-19 who require prolonged intubation. Robust investigations of the safety of tracheostomy protocols and provider adherence and evaluations are limited.

Objectives: To determine the rate of COVID-19 infection of health care personnel involved in COVID-19 tracheostomies under a multidisciplinary safety protocol and to investigate health care personnel's attitudes and suggested areas for improvement concerning the protocol.

Methods: All health care personnel involved in tracheostomies in COVID-19–positive patients from April 9 through July 11, 2020, were sent a 22-item electronic survey.

Results: Among 107 health care personnel (80.5%) who responded to the survey, 5 reported a positive COVID-19 test result (n = 2) or symptoms of COVID-19 (n = 3) within 21 days of the tracheostomy. Respondents reported 100% adherence to use of adequate personal protective equipment. Most (91%) were familiar with the tracheostomy protocol and felt safe (92%) while performing tracheostomy. Suggested improvements included creating dedicated tracheostomy teams and increasing provider choices surrounding personal protective equipment.

Conclusions: Multidisciplinary engagement in the development and implementation of a COVID-19 tracheostomy protocol is associated with acceptable safety for all members of the care team.


Since the first report of a novel coronavirus in Wuhan, China,[1] the persistence of the ensuing COVID-19 pandemic has created massive global challenges for public health, research, and health care.[2] Although many cases of COVID-19 are mild, patients with severe illness often require intensive care because of acute hypoxemic respiratory failure,[3] necessitating prolonged mechanical ventilation in up to approximately 12% of patients.[4] The increase in respiratory failure has resulted in an increased need for tracheostomies in patients with COVID-19.[5]

Because tracheostomies are highly aerosolizing procedures,[6,7] many authorities have raised concerns regarding the potential for transmission of COVID-19 to health care personnel during the procedure and have established recommendations to enhance patient and provider safety.[8–12] The data on rate of infection of health care personnel in association with tracheostomies have largely demonstrated limited viral transmission; however, most reports are anecdotal[13–16] or from cohorts of small teams of proceduralists, without consideration of the broader health care team.[17–24]

Researchers have advocated for health care personnel–centered studies to investigate the risk for COVID-19 transmission during tracheostomy,[25] yet few studies have included the entire complement of physicians, nurses, surgical technologists, and respiratory care practitioners involved in the procedure. In the current study, we describe the COVID-19 tracheostomy protocol implemented at our institution and investigate the rate of transmission of COVID-19 to health care personnel involved in tracheostomy procedures as well as the beliefs and attitudes of health care personnel concerning their own safety.