Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study
El-Boghdadly, K.; Wong, D. J.N.; Owen, R.; Neuman, M. D.; Pocock, S.; Carlisle, J. B.; Johnstone, C.; Andruszkiewicz, P.; Baker, P. A.; Biccard, B. M.; Bryson, G. L.; Chan, M. T.V.; Cheng, M. H.; Chin, K. J.; Coburn, M.; Fagerlund, M. J.; Myatra, S. N.; Myles, P. S.; O’Sullivan, E.; Pasin, L.; Shamim, F.; van Klei, W. A.; Ahmad, I.
(2020) Anaesthesia, volume 75, issue 11, pp. 1437 - 1447
(Article)
Abstract
Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on
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tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.
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Keywords: airway, coronavirus, COVID-19, healthcare workers, intubation, Pandemics, Prospective Studies, Humans, Middle Aged, Occupational Exposure/adverse effects, Proportional Hazards Models, Coronavirus Infections/epidemiology, Male, Risk, Health Personnel, Pneumonia, Viral/epidemiology, Betacoronavirus, Adult, Female, Intubation, Intratracheal, Anesthesiology and Pain Medicine, Journal Article, Research Support, Non-U.S. Gov't, Multicenter Study
ISSN: 0003-2409
Publisher: Wiley-Blackwell
Note: © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
(Peer reviewed)