• Am J Emerg Med · Jan 2021

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

    • Lauren M Westafer, William E Soares, Doug Salvador, Venkatrao Medarametla, and Elizabeth M Schoenfeld.
    • Department of Emergency Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA; Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA, USA. Electronic address: westafer@gmail.com.
    • Am J Emerg Med. 2021 Jan 1; 39: 158-161.

    BackgroundInitial 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.MethodsWe 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.ResultsDuring 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.ConclusionWe 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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