Emergency cesarean section in an epidemic of the middle east respiratory syndrome: a case report

Park, Mi Hye; Kim, Hee Ryun; Choi, Duck Hwan; Sung, Ji Hee; Kim, Jong Hwa

As we have no permanent negative pressure operating rooms at our institution, two operating rooms were converted to negative-pressure [13] . These rooms were connected, but had separate air-conditioning and humidification units with individual atmospheric air inlet and exhaust systems. We used one as the Surgery on an infectious patient operating theater and the other as a PPE changing room. The air pressure in these rooms was maintained at −4.7 Pa (operating theater) and −1.2 Pa (changing room). An airflow visualization (smoke) test was carried out to ensure negative pressure. Modifications were made to minimize outflow of contaminated air from the MERS-related operating rooms. Airflow in the operating room was > 14 air exchanges per hour. All anesthetic and surgical team staff used enhanced PPE comprised of a N95 mask, surgical cap, double gowns, double gloves, shoe covers, and powered air-purifying respirators. After the patient recovered from anesthesia in the operating room, the patient was transferred back to the ward by the same dedicated anesthesiologist who changed into new PPE to minimize MERS-CoV exposure. An N95 mask was fit on the patient during the transfer and Roberge et al. [14] reported that use of an N95 mask by a healthy women during late pregnancy did not change any physiological or subjective findings compared with those of healthy, non-pregnant women during sedentary activities and exercise for 1 hour. If a pregnant woman is infectious, they may be able to use an N95 mask without complications. Finally, the MERSdesignated spaces were all ventilated for 100 min and thoroughly decontaminated after the case. All medical staff involved in the delivery remained healthy.