Presence of viable SARS-CoV-2 virus in surgical smoke produced during electrocautery

Electrocautery is an important, and in many cases, essential tool used during surgery. It is well established that electrocautery can produce aerosol, and previous studies have demonstrated that some viruses can be carried in the vapours from cautery. During the COVID-19 pandemic, out of an abundance of caution, protocols have been put in place to minimize potential exposure to this smoke that significantly reduce the capacity in our healthcare system to do surgery. High level personal protective equipment is required for these procedures when they do occur, and much of that equipment is currently in short supply. This study will be done in a biohazard level 3 laboratory and will examine if the virus that causes COVID-19 (SARS-CoV-2) is viable and present in the smoke produced by using cautery. This study will collect the smoke from using two different types of cautery on blood from a patient with COVID-19, from blood inoculated with SARS-CoV-2 and from cauterizing a culture plate with SARS-CoV-2. The vapour will then be cultured to see if SARS-CoV-2 can be grown, thus demonstrating if viable virus is aerosolized during cautery. Another test (RT-PCR) will be used to look for RNA from the virus to see if any is present in the smoke. A positive control will be done using aerosolized blood from the same samples. The results from this study, whether positive or negative, will important implications. If positive, it will have a critical and direct impact on ensuring the safety of healthcare workers performing procedures on patients. Procedures using cautery will continue to require high level protection if the COVID status of the patient is unknown. If negative, it will significantly improve the ability of our healthcare system to perform surgical procedures safely and effectively, and conserving critical protective equipment for cases that need it.