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Asian Spine J > Volume 14(3); 2020 > Article
Sornsa-ard, Niramitsantiphong, and Liawrungrueang: Response to: Management of Traumatic Spinal Fracture in the Coronavirus Disease 2019 Situation
Dear Sir,
We appreciate the letter regarding our manuscript entitled “Management of traumatic spinal fracture in the coronavirus disease 2019 situation [1].” We thank the reader(s) for reading our article. Our reply to your comment is as follows:
Our reply: At first, the authors want to say thank you for the reader’s comments and concern. In our review article [1], all authors want to establish the prototype to help and protect the healthcare professional. This algorithm should be revised or modified according to updated knowledge of prevention, novel treatment, and laboratory testing technology for coronavirus disease 2019 (COVID-19). All of the authors hope that the readers will use this algorithm as a prototype and modify/develop for better protocol.
All authors agree with the reader recommending that universal precautions should be used in the surgical management of any patients during the COVID-19 outbreak [2,3]. Nakornping Hospital uses “Guideline for personal protective equipment usage for COVID-19 prevention in Nakornping Hospital Chiang Mai (The Committee of Infectious Disease Control Nakornping Hospital; the 2nd revision 16th April 2020)” (Table 1). If the reader requests the Thai version, please directly contact the Nakornping Hospital, Chiang Mai, Thailand.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Acknowledgments

Thank you to the Institutional Ethics Review Board at Nakornping Hospital for proof of this letter.

Table 1.
Guideline for PPE usage for COVID-19 prevention in Nakornping, Hospital Chiang Mai (The Committee of Infectious Disease Control Nakornping Hospital; the 2nd revision 16th April 2020)
Level of risk Patient care Example Level of PPE
1. Low risk - Take care patients with more than 2-m distancing - Medical professional who did history taking from patients - Surgical face mask
- Less than 2 m with less contact with patients and the environment with less time - Medical professional who did a thermoscan - Face shield
- Security guard protecting the patients during transfer
- A driver
2. Moderate risk - Patient care within 2-m distance and less time - Medical professional or nurses who took vital signs - Isolation gown
- A driver who did a COVID-19 ambulance cleaning - Surgical face mask
- Medical professional who did a COVID-19 postmortem transfer - Plastic apron (disposable)
- Goggle or face shield
- Disposable hair cover
- 2 Layers of disposable examination gloves
3. High-risk - Taking care of the patients less than 2 m with or without aerosol contamination - Medical professional who did a nasopharyngeal swab, throat swab, or oropharyngeal swab in high-risk COVID-19 patients - Long sleeves waterproof gown
- Doctors who did physical examination in high-risk COVID-19 ward - Disposable hair cover
- Medical professional or nurses who did ventilator care in high-risk COVID-19 ward. - N95 face mask
- Medical professional or nurses who transferred patients to another department - Goggles or face shield
- Radiologist who did X-ray in high-risk COVID-19 ward - 2 Layers of disposable examination gloves
- Medical professional or nurses who did CPR in the general ward
4. Very high-risk 1 - Taking care of COVID-19 patients, distance less than 2 m with aerosol contamination situation - Medical professional, doctor, or nurses who take care patients in transferring ambulance - Shoe cover and protective shoes
- Medical professional or nurses who did an airway suction in high-risk COVID-19 patients - Cover-all PPE
- Long sleeves waterproof gown
- Postmortem examination - N95 face mask
- Goggle or face mask
- 2 Layers of examination gloves
5. Very high-risk 2 - Taking care of COVID-19 patients, distance less than 2 m with aerosol contamination situation of more than 30 minutes - Medical professional, doctors, or nurses who transfer COVID-19 patients in ambulance - Leg cover and protective boots for bronchoscopy the others use shoes cover
- Medical professional or nurses who did a bronchoscopy, nasopharyngeal wash, nasopharyngeal aspiration, and surgical operations in high-risk COVID-19 patients - Cover-all PPE
- Long sleeves waterproof gown
- Medical professional or nurses who did CPR in high-risk COVID-19 patients - Disposable hair cover
- N95 face mask or powered air purifying respirators
- 2 Layers of surgical gloves in surgical procedures

PPE, personal protective equipment; COVID, coronavirus disease 2019; CPR, cardiopulmonary resuscitation; N95 face mask, National Institute for Occupational Safety and Health-approved face mask.

References

1. Sornsa-Ard T, Niramitsantiphong A, Liawrungrueang W. Management of traumatic spinal fracture in the coronavirus disease 2019 situation. Asian Spine J 2020 Apr 24 [Epub]. https://doi.org/10.31616/asj.2019.0183.
crossref
2. Centers for Disease Control and Prevention. What healthcare personnel should know about caring for patients with confirmed or possible COVID-19 infection [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 [cited 2020 Mar 6]. Available from: http://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html.

3. Centers for Disease Control and Prevention. Strategies for optimizing the supply of N95 respirators [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 [cited 2020 Apr 26]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html.



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