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, the persistence of the ensuing COVID-19 pandemic has created massive global challenges for public health, research, and health care. Although many cases of COVID-19 are mild, patients with severe illness often require intensive care because of acute hypoxemic respiratory failure, necessitating prolonged mechanical ventilation in up to approximately 12% of patients. The increase in respiratory failure has resulted in an increased need for tracheostomies in patients with COVID-19.
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, 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.
Am J Crit Care. 2022;31(6):452-460. © 2022 American Association of Critical-Care Nurses