Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices.

Autor:	Bellato V; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Konishi T; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan., Pellino G; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.; Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain., An Y; Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China., Piciocchi A; GIMEMA Foundation, Rome, Italy., Sensi B; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Siragusa L; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Khanna K; Department of Orthopaedic surgery, Rush University Medical Center, Chicago, IL, USA., Pirozzi BM; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Franceschilli M; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Campanelli M; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Efetov S; Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Sica GS; Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma 'Tor Vergata', Rome, Italy.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2020 Dec; Vol. 10 (2), pp. 020507.
DOI:	10.7189/jogh.10.020507
Abstrakt:	Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P  < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study Registration: Registered in ClinicalTrials.gov: NCT04344197. Competing Interests: Authorship contributions: Study conception and design: VB, TK, GP, YA, BS, GS. Acquisition of data: VB, TK, YA, BS, LS, BP, MF, MC. Analysis and interpretation of data: VB, TK, YA, AP, KK, SE. Drafting of manuscript: VB, TK, YA. Critical revision: GP, AP, BS, LS, KK, BP, MF, MC, SE, GS. Final approval: All the authors. Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest. (Copyright © 2020 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
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