‘Getting to zero’ cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic
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Tuangsit Wataganara
To the Editor,
We are pleased that our viewpoint article has generated interest in the infection control community [1], [2]. The matter of preventing cross contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) deserves further discussion as the pandemic still develops. We agree that prevention of healthcare-associated SARS-CoV-2 infection in pregnant women should not be limited only in the obstetric ultrasound suite. Proper disposal of face masks, personal protective equipment, and other medical waste (i.e. plastic probe covers and condoms) during the pandemic deserves significant attention by the concerned authorities [3]. The main assertion is that “zero-error” concept should be adopted for SARS-CoV-2, as well as all hospital-acquired infection [2]. Isolated reports of infection prevention campaigns resulting in zero hospital-acquired infections exist [4]. In reality, however, only 55–70% of hospital-acquired infections are potentially preventable [5].
Primary transmission of SARS-CoV-2 is human-to-human via oral and respiratory droplets with the virus-laden environment play a lesser role in the propagation of disease [6]. The main reason for cautioning the zero-error concept is our limited understanding of the physiopathology of SARS-CoV-2 infection. We still do not know why some individuals do, and others do not, develop coronavirus disease of 2019 (COVID-19), even after compliance with good practice guidelines and workflow policies [7]. Most people would consider that a “mistake” has been made somewhere along the line, but nobody knows if this is really the case [8]. The clinically compatible risk management concept should therefore include blame-free reporting, collective use of reported events for root-cause analysis, and continuous quality improvement. “Getting-to-zero” concept may be an alternative policy framework for the elimination of hospital-associated infections [9].
Our described protocol is subjected for adaptation for various levels of clinical settings [1]. Minimizing risk is a challenge that has to be met jointly by medical teams, hospital managers, and patients’ associations in a climate of transparency. Additional preventative measures should be implemented and explained when risks escalate, but these measures will not reduce the risk to zero [7].
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Research funding: None declared.
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Author contributions: The author has accepted respon-sibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
References
1. Wataganara, T, Ruangvutilert, P, Sunsaneevithayakul, P, Sutantawibul, A, Chuchotirot, M, Phattanachindakun, B, et al.. Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic. J Perinat Med 2020;48:931–42. https://doi.org/10.1515/jpm-2020-0228.Search in Google Scholar PubMed
2. Joob, B, Wiwanitkit, V. Cross transmission of SARS-CoV-2 and obstetric ultrasound. J Perinat Med 2021;49:397. https://doi.org/10.1515/jpm-2020-0557.Search in Google Scholar PubMed
3. Peng, J, Wu, X, Wang, R, Li, C, Zhang, Q, Wei, D. Medical waste management practice during the 2019–2020 novel coronavirus pandemic: experience in a general hospital. Am J Infect Control 2020;48:918–21. https://doi.org/10.1016/j.ajic.2020.05.035.Search in Google Scholar PubMed PubMed Central
4. Magill, SS, O’Leary, E, Janelle, SJ, Thompson, DL, Dumyati, G, Nadle, J, et al.. Emerging Infections Program Hospital Prevalence Survey, Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med 2018;379:1732–44.10.1056/NEJMoa1801550Search in Google Scholar PubMed PubMed Central
5. Bearman, G, Doll, M, Cooper, K, Stevens, MP. Hospital infection prevention: how much can we prevent and how hard should we try? Curr Infect Dis Rep 2019;21:2. https://doi.org/10.1007/s11908-019-0660-2.Search in Google Scholar PubMed
6. Lotfi, M, Hamblin, MR, Rezaei, N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020;508:254–66. https://doi.org/10.1016/j.cca.2020.05.044.Search in Google Scholar PubMed PubMed Central
7. Carlet, J, Fabry, J, Amalberti, R, Degos, L. The “zero risk” concept for hospital-acquired infections: a risky business!. Clin Infect Dis 2009;49:747–9. https://doi.org/10.1086/604720.Search in Google Scholar PubMed
8. Wataganara, T, Sutantawibul, A, Anuwutnavin, S, Leelaporn, A, Rongrungruang, Y. Puerperal retroperitoneal abscess caused by Clostridium difficile: case report and review of the literature. Surg Infect (Larchmt) 2014;15:829–33. https://doi.org/10.1089/sur.2012.104.Search in Google Scholar PubMed
9. Richards, C. Getting to zero: an emerging policy framework for the elimination of hospital-associated infections. Infect Control Hosp Epidemiol 2009;30:71–3.10.1086/595858Search in Google Scholar PubMed
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- Clinical evaluation of labor: an evidence- and experience-based approach
- Original Articles – Obstetrics
- How fever is defined in COVID-19 publications: a disturbing lack of precision
- Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection
- Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden
- Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia – implications for clinical care
- Cytokine profiling: variation in immune modulation with preterm birth vs. uncomplicated term birth identifies pivotal signals in pathogenesis of preterm birth
- Hyperechoic amniotic membranes in patients with preterm premature rupture of membranes (p-PROM) and pregnancy outcome
- A novel technique for prediction of preterm birth: fetal nasal flow Doppler
- Pregnant women’s knowledge and behaviour to prevent cytomegalovirus infection: an observational study
- Reference intervals and reliability of cavum septi pellucidi volume measurements by three-dimensional ultrasound between 19 and 24 weeks’ gestation
- First-trimester presentation of ultrasound findings in trisomy 13 and validation of multiparameter ultrasound-based risk calculation models to detect trisomy 13 in the late first trimester
- Pre-operative tranexemic acid vs. etamsylate in reducing blood loss during elective cesarean section: randomized controlled trial
- External validation of a prediction model on vaginal birth after caesarean in a The Netherlands: a prospective cohort study
- The influence of race on cervical length in pregnant women in Brazil
- Original Articles – Fetus
- A 24-segment fractional shortening of the fetal heart using FetalHQ
- Original Articles – Neonates
- Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry
- Acute respiratory effect of transpyloric feeding for respiratory exacerbation in preterm infants
- Quality improvement for reducing utilization drift in hypoxic-ischemic encephalopathy management
- Letter to the Editor
- Cross transmission of SARS-CoV-2 and obstetric ultrasound
- ‘Getting to zero’ cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic
Articles in the same Issue
- Frontmatter
- Review
- Clinical evaluation of labor: an evidence- and experience-based approach
- Original Articles – Obstetrics
- How fever is defined in COVID-19 publications: a disturbing lack of precision
- Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection
- Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden
- Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia – implications for clinical care
- Cytokine profiling: variation in immune modulation with preterm birth vs. uncomplicated term birth identifies pivotal signals in pathogenesis of preterm birth
- Hyperechoic amniotic membranes in patients with preterm premature rupture of membranes (p-PROM) and pregnancy outcome
- A novel technique for prediction of preterm birth: fetal nasal flow Doppler
- Pregnant women’s knowledge and behaviour to prevent cytomegalovirus infection: an observational study
- Reference intervals and reliability of cavum septi pellucidi volume measurements by three-dimensional ultrasound between 19 and 24 weeks’ gestation
- First-trimester presentation of ultrasound findings in trisomy 13 and validation of multiparameter ultrasound-based risk calculation models to detect trisomy 13 in the late first trimester
- Pre-operative tranexemic acid vs. etamsylate in reducing blood loss during elective cesarean section: randomized controlled trial
- External validation of a prediction model on vaginal birth after caesarean in a The Netherlands: a prospective cohort study
- The influence of race on cervical length in pregnant women in Brazil
- Original Articles – Fetus
- A 24-segment fractional shortening of the fetal heart using FetalHQ
- Original Articles – Neonates
- Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry
- Acute respiratory effect of transpyloric feeding for respiratory exacerbation in preterm infants
- Quality improvement for reducing utilization drift in hypoxic-ischemic encephalopathy management
- Letter to the Editor
- Cross transmission of SARS-CoV-2 and obstetric ultrasound
- ‘Getting to zero’ cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic
