No evidence of increasing COVID-19 in health care workers after implementation of high flow nasal cannula: A safety evaluation

Abstract

Background Initial recommendations discouraged high flow nasal cannula (HFNC) in COVID-19 patients, driven by concern for healthcare worker (HCW) exposure. Noting high morbidity and mortality from early invasive mechanical ventilation, we implemented a COVID-19 respiratory protocol employing HFNC in severe COVID-19 and HCW exposed to COVID-19 patients on HFNC wore N95/KN95 masks. Utilization of HFNC increased significantly but questions remained regarding HCW infection rate. Methods We performed a retrospective evaluation of employee infections in our healthcare system using the Employee Health Services database and unit records of employees tested between March 15, 2020 and May 23, 2020. We assessed the incidence of infections before and after the implementation of the protocol, stratifying by clinical or non-clinical role as well as inpatient COVID-19 unit. Results During the study period, 13.9% (228/1635) of employees tested for COVID-19 were positive. Forty-six percent of infections were in non-clinical staff. After implementation of the respiratory protocol, the proportion of positive tests in clinical staff (41.5%) was not higher than that in non-clinical staff (43.8%). Of the clinicians working in the high-risk COVID-19 unit, there was no increase in infections after protocol implementation compared with clinicians working in COVID-19 units that did not use HFNC. Conclusion We found no evidence of increased COVID-19 infections in HCW after the implementation of a respiratory protocol that increased use of HFNC in patients with COVID-19; however, these results are hypothesis generating.

High flow nasal cannula for adult acute hypoxemic respiratory failure in the ED setting

“…Early in the COVID-19 pandemic, infection control concerns surrounding use of HFNC led many to favor endotracheal intubation in order to limit potential aerosol generation and dispersion. Evaluation of past and emerging data coupled with hard-won clinical experience have dispelled many of these concerns [ 103 , 104 ]. In one healthcare system, implementation of a respiratory protocol increasing the use of HFNC in a dedicated COVID-19 intermediate care unit with non-negative pressure rooms did not result in any significant increase in symptomatic COVID-19 infections among staff compared to those working in COVID-19 units not using HFNC [ 104 ].…”

High-Flow nasal cannula treatment in patients with COVID-19 acute hypoxemic respiratory failure: A prospective cohort study

“…[ 25 ] However, multiple studies generated a cumulative low-moderate quality of evidence, which indicate a relatively low risk of dispersing a significant amount of bio-aerosol particles and suggest no increase in the risk of infection transmission to healthcare workers with an excellent fitted HFNC, good sealing circuit, and appropriate adherence to airborne precautions. [ 26 25 24 25 26 27 28 29 30 31 ] Yet, high-quality evidence on the risk of airborne contamination and nosocomial infection with the use of HFNC for the management of COVID-19 patients is needed.…”

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

“…During a cough-simulating scenario, HFNO moderately increased the distance of droplet dispersion by an average of 0.42 m [ 74 ]. On the other hand, other investigators demonstrated that there was no significant difference in the risk of aerosol production and dispersion between spontaneous breathing, conventional oxygen treatment and HFNO or NIV therapy [ 75 , 76 , 77 , 78 , 79 , 80 , 81 ], and that these modalities do not expose healthcare workers to higher infection risk provided that they follow the appropriate personal protection precautions [ 82 , 83 , 84 ]. In a very interesting recent article by Gaeckle and coworkers, aerosol generation from healthy participants receiving oxygen via a non-humidified nasal cannula, face mask, HFNO and NIV was measured during normal breathing, talking, deep breathing and coughing [ 75 ].…”