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Healthcare Worker Risk After Intubation of COVID-19 Patients
Quick Takes
- The risk to a healthcare worker of acquiring COVID-19 during intubation of an infected patient is unknown.
- 10.7% of clinicians from a multinational cohort reported subsequent confirmed COVID-19 diagnosis or development of symptoms requiring a period of self-isolation following intubation of a patient with known or suspected COVID-19 infection.
- Although females were more likely than males to become infected or to develop symptoms requiring self-isolation, no other demographic or procedural risks were identified from this cohort that affected the outcome.
Study Questions:
How great is the risk to healthcare workers of acquiring coronavirus disease 19 (COVID-19) during tracheal intubation of a patient with known or suspected COVID-19 infection?
Methods:
Healthcare workers from 503 hospitals in 17 countries were invited to enroll in a registry to document episodes in which they performed tracheal intubation for patients with known or suspected COVID-19 infection. Demographic characteristics of the clinician-participant (seniority, medical specialty, operator vs. observer, gender), procedural details (intubating equipment and technique, personal protection equipment [PPE] specifics), and indication for intubation were tabulated. The primary study outcome was subsequent laboratory-proven COVID-19 diagnosis, or onset of symptoms requiring self-isolation or hospitalization in the clinician participant.
Results:
A total of 1,718 clinician participants from 503 hospitals in 17 countries performed 5,148 tracheal intubations between March 23–June 2, 2020. The primary outcome occurred in 184 participants (10.7%) over a median (interquartile [range]) of 32 (18-48 [0-116]) days. Laboratory-confirmed COVID-19 infection developed in 53 (3.1%), and hospitalization was required in two (0.1%) participants. Cumulative incidence of primary outcome and laboratory-confirmed COVID-19 infection were 3.6%, 6.1%, 8.5% and 0.7%, 1.6%, 2.6% within 7, 14, and 21 days of the intubation episode. World Health Organization (WHO)-recommended protection for aerosolizing procedures (face covering [powered air-purifying respirator [PAPR], N95, or equivalent], eye protection, gown, and gloves) were worn during 88% of the intubation episodes. Multivariate analysis showed significant association with female gender (hazard ratio 1.36 [1.01, 1.82]), but no significant association between intubation techniques or other demographic characteristics.
Conclusions:
This ongoing prospective cohort examining the risk to clinicians responsible for intubating patients with known or suspected COVID-19 infection showed that 10.7% required self-isolation and 3.1% developed confirmed COVID infection over a 2- to 6-week study period. PPE use failed to meet the minimum WHO-recommended standards recommended in 12% of registered intubations, and the total number of participants acquiring asymptomatic COVID-19 infection during the study period is unknown.
Perspective:
These findings underscore the significant burden of incident COVID-19 infection and symptoms requiring isolation to clinicians after performing intubation on infected patients. Expansion of the cohort in the future to include age-matched members of the healthcare community not participating in airway management would help establish a causal relationship between COVID-19 infection risk associated with tracheal intubation.
Clinical Topics: COVID-19 Hub, Prevention
Keywords: Airway Management, Anesthesia, Coronavirus, COVID-19, Health Personnel, Intubation, Intratracheal, Personal Protective Equipment, Respiratory Protective Devices, Risk Assessment, Secondary Prevention, severe acute respiratory syndrome coronavirus 2
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