Governance Organization

SHS – Sunnybrook Medical Services Alternative Funding Plan Association

Project Title

SHS-21-004 – Risks to medical teams caring for Obstetrical and Surgical patients with COVID-19: Is SARS-CoV-2 virus present in the female reproductive tract, the peritoneal surface, surgical smoke and/or surgical masks?

Project Highlights

Surgical and obstetrical care requires close and “hands-on” contact with patients for a prolonged period of time. Little is known about 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. There are risks to the HCWs, but also risks to patients’ access to care, shown for example, when two hospitals in Toronto banned laparoscopic surgery in March 2020 due to the unknown risks of infection to HCWs (theoretical risk of aerosolization of virus with the positive pressure insufflation used with laparoscopy). This approach subjected patients to more morbid open abdominal surgery.

The exposure risks to front-line health care workers (HCWs) caring for patients with COVID-19 undergoing surgery or obstetrical delivery, is unclear. Understanding which sample types that may harbour virus is important for evaluating risk.

Aim: To determine if SARS-CoV-2 viral RNA from patients with COVID-19 undergoing urgent surgery or obstetrical delivery is present in: 1) the peritoneal cavity of males and females 2) the female reproductive tract, 3) the environment of the surgery or delivery suite (surgical instruments, equipment used, air or floors) and 4) inside the masks of the attending health care workers.

Methods: In this cross-sectional study, conducted at two Toronto hospitals, 32 patients with COVID-19 underwent urgent surgery or obstetrical delivery and the presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real time reverse transcriptase polymerase chain reaction. Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of HCW masks positive for SARS-CoV-2 RNA.

Results: SARS-CoV-2 RNA was detected in 20/332 (6%) patient and environmental samples collected: 4/24(16.7%) patient, 5/60(8.3%) floor, 1/54(1.9%) air, 10/23(43.5%) surgical instruments/equipment, 0/24 cautery filters and 0/143(95%CI, 0-0.026) inner surface of mask samples.

Interpretation: While there is evidence of SARS-CoV-2 RNA in the surgical and obstetrical operative environment, the finding of no detectable virus inside the masks worn by the medical teams would suggest a low risk of infection for our health care workers using appropriate personal protective equipment.

Although these results may be reassuring and suggest that our health care workers’ PPE are adequate, more studies may be needed to further define exact risks of infection. To our knowledge, this is the first study evaluating potential exposure risks to HCWs in the operating room with a variety of surgical procedures (that are not known to be aerosol generating). As COVID-19 is likely to continue to circulate and be endemic, even in the presence of vaccines, knowledge of HCW risks will be essential to allow us to determine the optimal means to protect HCWs and for health care workforce planning.

As COVID-19 variants of concern evolve, we plan to continue to study patients with COVID-19 who require urgent surgery/obstetrical delivery and we will aim to compare rates of contamination between the different variants. We have also initiated an electronic survey, to conduct follow up study of HCWs’ health after their exposure to a patient with COVID-19. This study contributes to the body of research that is relevant to health care workers and health care systems.


Methods of Risk Reduction and Mitigation

Primary Project Lead for Contact

Patricia Lee


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