The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a highly infectious and positive-stranded ribonucleic acid (RNA) virus that was first reported for the first time in Wuhan, China in 2019. Since then, SARS-CoV-2 has infected over 225 million people across the world and, to date, has claimed more than 4.6 million lives.
Study: Detection of SARS CoV-2 contamination in the Operating Room and Birthing Room Setting: Risks to attending health care workers. Image Credit: UfaBizPhoto / Shutterstock.com
Frontline healthcare workers at a high risk of COVID-19
Healthcare workers (HCWs) are at a high risk of contracting SARS-CoV-2 while treating patients with the coronavirus disease 2019 (COVID-19). Although the transmission of SARS-CoV-2 is facilitated through known vectors such as respiratory droplets, aerosols, and fomites, the infection may also be passed via exposure to the virus from surgery or obstetrical delivery. It is not clear if a specific type of surgical/obstetrical procedure presents more risks to HCWs than others.
Researchers have reported the presence of SARS-CoV-2 in the gastrointestinal (GI) tract. Hence, surgeries associated with opening the GI tract may pose a risk to medical teams. SARS-CoV-2 is also found in the peritoneal fluid from COVID-19 patients undergoing surgery. In females, SARS-CoV-2 RNA was found to be present in the reproductive tract.
The presence of SARS-CoV-2 on peritoneal surfaces, the female reproductive tract, or the myometrium poses a high risk of it being aerosolized through cautery smoke or from the release of carbon dioxide (CO2) gas from laparoscopic procedures. Although there is no evidence that shows the presence of SARS-CoV-2 in the surgical smoke/plume, previous studies have indicated the presence of other viruses such as Human Immunodeficiency Virus -1, human papillomavirus (HPV), and Hepatitis B virus in surgical smoke.
Previous studies have also documented the presence of SARS-CoV-2 in hospital ward settings. However, there is a gap in research related to the assessment of the risk of SARS-CoV-2 viral contamination in the operating room (OR) and birthing settings.
A new study
A new study published on the preprint server medRxiv* assesses the risk of contamination in the OR and birthing suite environment. In this study, the authors evaluated the risk of aerosolization from the respiratory tract or the surgical or obstetrical settings during surgery, labor, and delivery.
The main significance of this study is to determine the likelihood of HCWs contracting COVID-19 during vaginal delivery or cesarean section, as well as other surgical procedures. This study provided HCWs best practices regarding the use of personal protective equipment (PPE) and other safety measures in the OR and birthing rooms that would protect them from COVID-19.
The main objective of this study was to determine if the viral RNA from patients with COVID-19 undergoing surgery or obstetrical care is present in the peritoneal cavity, the female reproductive tract, the entire surgical environment including the instruments, air, floors of the surgery room, and inside the masks of the attending health care workers. Herein, the researchers used a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test to detect the presence of SARS-CoV-2 viral RNA. In this study, researchers obtained the air samples using both active and passive sampling techniques.
In the current study, the researchers detected SARS-CoV-2 RNA in non-respiratory patient samples such as peritoneal fluid, vaginal fluid, myometrium, and the placenta. SARS-CoV-2 was also found in the surgical equipment/instruments such as endotracheal tubes, gastroscope, laparotomy surgical clamps, and scissors, as well as in the air and floor of the surgical room. Interestingly, no trace of the virus was found in the surgical masks worn by the HCWs.
The researchers did not detect any viral RNA in the equipment used by orthopedics such as saw blade and drill bits, or in the equipment of cardiac/thoracic surgeons (e.g., retractors), and burn surgeries (e.g., dermatome). This result indicates that SARS-CoV-2 is less likely to reside in these types of tissues.
As the frequency of positive tests was low, the researchers suggested aerosolization of the virus does not occur in surgery. Further, the researchers could not find any evidence of SARS-CoV-2 RNA in the smoke evacuator filters tested. However, this result is not sufficient to conclude that viral contamination does not occur via surgical smoke.
One of the limitations of this study is that the researchers excluded data associated with the development of infection in HCWs from hospital settings and their vaccination status. In the context of obtaining samples from the air, despite two detection methods being used in this study, there is a chance that some viral contamination was undetected.
The authors revealed that no trace of SARS-CoV-2 was found inside the masks worn by the medical teams. Therefore, the proper use of PPE would ensure a low risk of COVID-19 infection.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.