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Assessing the Risk of SARS-CoV-2 Transmission via Surgical Electrocautery Plume

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been detected in saliva, sputum, bile, feces, and blood and shown to remain viable in aerosols for at least 3 hours.1,2 As such, direct transmission to surgical staff from aerosolized virus in an electrocautery plume (as observed with other viruses) has been raised by several colleges and associations as a particular safety concern.1,3 Cautery performed in areas of high potential viral load in particular (eg, the nasopharynx, oropharynx, anterior skull base, lung parenchyma) could pose a risk to those in the operating room. Furthermore, sinonasal pathologies can mimic the symptom profile of COVID-19 and have been documented to contribute to false-negative nasopharyngeal screening results, further increasing potential perioperative risk and exposure.4

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Article Information

Accepted for Publication: April 3, 2021.

Published Online: May 21, 2021. doi:10.1001/jamasurg.2021.2591

Corresponding Author: Leigh J. Sowerby, MD, MHM, Department of Otolaryngology–Head and Neck Surgery, Western University, St Joseph’s Hospital, 268 Grosvenor St, London, B2-501 ON, Canada (leigh.sowerby@sjhc.london.on.ca).

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Sowerby LJ et al. JAMA Surgery.

Author Contributions: Dr Sowerby had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Sowerby, Gibson, Moore, Arts.

Drafting of the manuscript: Sowerby, Nichols, Gibson, Sommer, Moore, Arts.

Critical revision of the manuscript for important intellectual content: Sowerby, Gibson, Sommer, Moore, Fraser, Arts.

Statistical analysis: Gibson, Arts.

Obtained funding: Sowerby, Nichols, Moore, Fraser.

Administrative, technical, or material support: Sowerby, Sommer, Moore, Fraser, Arts.

Supervision: Nichols, Sommer, Moore, Arts.

Conflict of Interest Disclosures: Dr Sowerby reported personal fees from Medtronic outside the submitted work. Dr Sommer reported speaking fees from Medtronic and advisory board fees from Sanofi and GlaxoSmithKline relating to biologic treatment for nasal polyps. No other disclosures were reported.

Funding/Support: This study was funded by the Canadian Institutes of Health Research Operating Grant: COVID-19 Rapid Research Funding Opportunity–Clinical Management and Health System Interventions.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
van Doremalen  N , Bushmaker  T , Morris  DH ,  et al.  Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.   N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973PubMedGoogle ScholarCrossref
2.
Zakka  K , Erridge  S , Chidambaram  S ,  et al; PanSurg collaborative group.  Electrocautery, diathermy, and surgical energy devices: are surgical teams at risk during the COVID-19 pandemic?   Ann Surg. 2020;272(3):e257-e262. doi:10.1097/SLA.0000000000004112PubMedGoogle ScholarCrossref
3.
Sawchuk  WS , Weber  PJ , Lowy  DR , Dzubow  LM .  Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection.   J Am Acad Dermatol. 1989;21(1):41-49. doi:10.1016/S0190-9622(89)70146-8PubMedGoogle ScholarCrossref
4.
Bleier  BS , Welch  KC .  Preprocedural COVID-19 screening: do rhinologic patients carry a unique risk burden for false-negative results?   Int Forum Allergy Rhinol. 2020;10(10):1186-1188. doi:10.1002/alr.22645PubMedGoogle ScholarCrossref
5.
Chin  AWH , Chu  JTS , Perera  MRA ,  et al.  Stability of SARS-CoV-2 in different environmental conditions.   Lancet Microbe. 2020;1(1):e10. doi:10.1016/S2666-5247(20)30003-3PubMedGoogle Scholar
6.
Banerjee  A , Nasir  JA , Budylowski  P ,  et al.  Isolation, sequence, infectivity, and replication kinetics of severe acute respiratory syndrome coronavirus 2.   Emerg Infect Dis. 2020;26(9):2054-2063. doi:10.3201/eid2609.201495PubMedGoogle ScholarCrossref
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