INNOVATION FUND The Future of Academic Medicine Innovative Approaches to Care Delivery, Public Health, and Equity, Diversity & Inclusion SHOWCASE 2023

Risks to medical teams caring for COVID-19 Obstetrical and Surgical patients: Is SARS-CoV-2 virus present in the female reproductive tract, the peritoneal surface, surgical smoke and/or surgical masks?

Innovative Approaches to Care Delivery, Public Health, and Equity, Diversity & Inclusion

Patricia Lee
(416) 480-6100, ext. 66740


Sunnybrook Health Sciences Centre, University of Toronto
Sunnybrook Research Institute


Darian Perruzza


Sunnybrook Health Sciences Centre
University of Toronto, University of Alberta


Surgical and obstetrical care requires close and “hands-on” contact with patients for a prolonged time periods. Information was lacking regarding the exact risks of SARS-CoV-2 infection in health care workers (HCWs) who care for patients with COVID-19 in the unique setting of the operating room and the obstetrical delivery room. At the beginning of the pandemic, many nurses and surgeons were concerned about working in such an environment and worried that their PPE (personal protective equipment) supply would be limited and inadequate. We conducted a cross-sectional study to assess contamination of SARS-CoV-2 RNA in a tertiary care hospital operating room and birthing room setting and found evidence of contamination in patient related samples, surgical equipment, air and floor samples but not inside HCWs masks. This finding is reassuring evidence for HCWs who use appropriate PPE in these work environments.


The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers.

We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers’ masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties).

Results: A total of 32 patients (age 20–88 years) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic/trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20/332 (6%) patient and environmental samples collected: 4/24 (17%) patient samples, 5/60 (8%) floor samples, 1/54 (2%) air samples, 10/23 (43%) surgical instrument or equipment samples, 0/24 cautery filter samples and 0/143 (95% confidence interval 0–0.0


PMID: 35609928 (published manuscript in CMAJ Open) (published abstract in JOGC)

Second manuscript submitted and under review, preprint available at

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