Recommendations to decrease exposure to the SARS-CoV-2 virus

Received on: 10/05/2020
Approved on: 30/05/2020

Financial support: None
Conflict of interest: None

During the COVID-19 pandemic, it is vitally important for dermatologists to seek the best ways to treat their patients and at the same time guarantee safety for themselves, their staff, and of course their patients. It is thus essential to know the prevailing guidelines and the protocols for definition of clinical cases, in order to determine whether the care should be performed in person or by telemedicine, or even postponed.

In case of dermatologic surgery, the first step is to determine the nature of the procedure’s urgency. However, in situations involving on-site care at the clinic or office, physicians and their staff should follow the guidelines for the appropriate use of personal protective equipment (PPE).

Important care for healthcare workers includes wearing masks and washing hands frequently with soap and water or sanitizing hands with alcohol. Hand sanitizing should be done before and after the procedure on the patient. An excellent tip is to read “My Five Moments for Hand Hygiene”, by the World Health Organization (WHO). It is also recommended not to wear nail polish or jewelry below the elbows, such as rings and bracelets. To avoid contamination of the hair, the hair should be kept short or tied up so that it is completely covered by the surgical cap during the procedure. The office should be sanitized frequently due to the possibility of viral transmission by fomites. SARS-COV-2 is easily inactivated by adequate disinfection, that is, cleaning surfaces with sodium hypochlorite or 75% alcohol.

For patients, the current guidelines aim to reduce the risk of exposure, that is, to avoid contact between patients in the waiting room, allowing only one patient to enter at a time or maintaining a distance of at least one meter between them. Patients should be encouraged to come to the office without accompanying persons and wearing a mask, as well as to wash their hands upon entering and exiting the clinic.

Except for dermatologic urgencies and cases in which a delay in the surgical procedure could increase the morbidity and mortality, patients that have tested positive for COVID-19 or those with symptoms consistent with the infection, such as fever, respiratory symptoms, myalgia, anosmia, chills, and others should have their procedure postponed by at least 14 days after the onset of symptoms. This recommendation also applies to healthcare workers and support staff, considering the unavailability of laboratory tests in some regions, as well as the tests’ sensitivity.

The ideal care for patients is that the healthcare professional wears a N95 mask, and when patients present respiratory symptoms, the professional should be wearing a disposable gown and gloves as well as a plastic face shield or the equivalent. The N95 mask should not be worn for more than eight hours consecutively or five days intermittently. Rigorous care should be taken in cases of surgery involving the mouth and/or nose, due to the risk of presence of high viral load in the secretions; in such situations, a smoke evacuation device may be indicated.

Thus, far, blood does not appear to be a potential route for coronavirus transmission, but the use of electric scalpels may create aerosols of viral particles, consistently increasing the risk of contamination. Sterilization of the surgical instruments should comply with the standard techniques already adopted by the Brazilian Society of Dermatologic Surgery.

Finally, since COVID-19 is still a poorly understood disease without a known effective treatment, professional responsibility for patients in the field of dermatology should be based strictly on the technical knowledge of the guidelines for prevention and responsible orientation of patients that come to the office or clinic for dermatologic procedures.

AUTHOR’S CONTRIBUTION:

Luciana Maragno | 0000-0002-6376-1523
Elaboration and writing of the manuscript; critical review of the literature.

REFERENCES

1. Decker A, Heaton H, Lawrence N. Reopening the dermatologic surgery office in the covid-19 era. [Internet]. Illinois; [updated 2020 May 20]. Available from: http://www.aad.org/dw/dw-insights-and-inquiries/2020-archive/may/reopening-the-opening-the-dermatologic-surgery-office.

2. Organização Pan-Americana da Saúde (BR), Organização Mundial da Saúde. Prevenção e controle de infecção durante os cuidados de saúde quando houver suspeita de infecção pelo novo coronavírus (nCOV): diretrizes provisórias. [Internet]. Brasília, Genebra; [updated 2020 Mar 03]. Available from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125.

3. Livingston EH. Surgery in a time of uncertainty a need for universal respiratory precautions in the operating room. JAMA. 2020. Epub 2020 May 7.