Abstract
The physician and patient come into close contact during botulinum toxin treatments, increasing the chances of COVID-19 infection. Therefore, it is essential to use an effective injection method that can prevent infection with SARS-CoV-2 virus. In order to minimize the risk of SARS-CoV-2 transmission during botulinum toxin treatment in the COVID-19 era, the Italian Botulinum Toxin Network study group of the Italian Society of Neurology has prepared a video of best practice recommendations on how to organize the work of a clinic performing botulinum toxin treatments.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10072-021-05375-z.
Keywords: Safe botulinum toxin injection, COVID-19 pandemic, SARS-CoV-2 infection, Italian Botulinum Toxin Network recommendations
The following text summarizes information provided in the video:
Overview
In order to minimize the risk of SARS-CoV-2 transmission during botulinum toxin treatment in the COVID-19 era, the Italian Botulinum Toxin Network has prepared a video of best practice recommendations to make botulinum toxin therapy safe in patients with dystonia, spasticity, chronic migraine, primary hyperhidrosis and sialorrhea [1].
Recommendations to prevent SARS-CoV-2 infection during botulinum toxin treatment
Structural recommendations [2]:
Daily sanitization of environments to be used for botulinum toxin infiltration;
Control of the patient’s body temperature at the entrance to the facility;
Arrangement of suitable interpersonal distancing measures in the waiting room;
Availability and provision of personal protective equipment (PPE) such as surgical masks or FFP2, footwear, headgear, disposable gown, gloves and visors/glasses and sanitizing agents for healthcare personnel [3];
Disposable material, hand disinfectant and surgical masks for the patient.
Patients are instructed as follows:
Come to the outpatient clinic with a protective surgical mask and nitrile gloves (also for accompanying persons);
The accompanying person must wear the protective surgical mask and, after accompanying the patient, must wait outside the clinic or hospital during treatment with botulinum toxin.
Botulinum toxin injection procedure:
The patient must treat the hands with hydroalcoholic or chlorine gel before entering the clinic. It is mandatory for the patient to wear non-sterile gloves and a surgical mask;
Doctor and staff remove all jewellery and personal items. Wash hands for at least 20 s with soap and water or alcohol solution. Wear the first pair of gloves. Wear footwear and headgear, then over the uniform the disposable gown, then mask FFP2; wear goggles or visor and wear the second pair of gloves [4];
When changing each patient, follow the sequence indicated, remove the second pair of gloves together with the disposable gown, remove the goggles or visor and sanitize them. Practice hand hygiene with soap and water or alcohol solution. In addition, if the botulinum toxin infiltration procedure involves treatment in the craniocervical districts or near the oral cavity [5], it is mandatory that healthcare professionals change the FFP2 mask after each infiltration [6], unless a protective visor is used;
Clean all surfaces with which the patient has come into contact (bed, chair) when changing patients with hydroalcoholic disinfectants (ethyl alcohol at 70°) or chlorinated disinfectants (0.1% sodium hypochlorite solutions). The most exposed surfaces should be protected with disposable barriers which, at the end of the session, should be replaced by special waste. Frequently change the air between patients in the clinic [7].
Conclusions
When these instructions are properly followed, they make the botulinum toxin injection procedure safe for the patient and the medical staff. New knowledge about SARS-CoV-2 infection may lead to changes in the suggested rules of good practice.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
Italian Botulinum Toxin Network Safe Infiltration Project participants:
Albanese M.; Albani G.; Assetta M.; Autunno M.; Babbini M.T.; Balestrieri F.; Barbero P.; Barbieri S.; Bargellesi S.; Bentivoglio A.; Bertolasi L.; Bizza M.; Capone L.; Cassano D.; Castagna A.; Castronovo G.; Cerchi A.; Cesaretti C.; Cevoli S.; Coletti Moja M.; Corradini C.; Crapanzano F.; Danni M.C.; De Bartolo M.; De Fazio G.; Del Colle R.; Doretti A.; Fazio N.; Flamma G.; Frasson E.; Frontoni M.; Giorgianni R.; Girlanda P.; Grazzi L.; Inglese C.; Leggio U.; Lettieri C.; Liberini P.; Liotti V.; Lo Fermo S.; Lori S.; Lozza A.; Maggi L.; Maggioni G.; Mampreso E.; Manzo L.; Marchese R.; Marinelli L.; Masi G.; Milano E.; Misceo S.; Moccia M.; Osio M.; Petracca M.; Pascarella A.; Polidori L.; Pozzolante R.; Prudenzano M.P.; Romano M.C.; Rossi V.; Sacco S.; Sances G.; Santoro A.; Scaglione Cesa L.; Sidoti V; Soliveri P.; Squintani G.M.; Tambasco N.; Terranova C.; Torelli P.; Truscello C.; Valzania F.
Data availability
The data that support the findings of this study are available on request from the corresponding author.
Code availability
Not applicable.
Declarations
Conflict of interest
The authors declare no competing interests.
Ethical approval
Institutional Review Board approval was obtained for this study.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Footnotes
The original online version of this article was revised: The above article was published with error. The author names inside the institutional group "Italian Botulinum Toxin Network -study group of Italian Society of Neurology" were missing in the xml tagging.
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Change history
12/29/2022
A Correction to this paper has been published: 10.1007/s10072-022-06591-x
Contributor Information
Francesco Bono, Email: f.bono@unicz.it.
on behalf of the Italian Botulinum Toxin Network -study group of Italian Society of Neurology:
Maria Albanese, Giovanni Albani, Maurizio Assetta, Massimo Autunno, Maria Teresa Babbini, Fabrizio Balestrieri, Pierangelo Barbero, Sergio Barbieri, Stefano Bargellesi, Anna Rita Bentivoglio, Laura Bertolasi, M. Bizza, Loredana Capone, Daniela Cassano, Anna Castagna, Gioacchino Castronovo, Alessandra Cerchi, Chiara Cesaretti, Sabina Cevoli, Mario Coletti Moja, Claudio Corradini, Floriana Crapanzano, Maura Chiara Danni, Matteo De Bartolo, Giovanni De Fazio, Raffaele Del Colle, Alberto Doretti, Nunzio Fazio, Giovanni Flamma, Emma Frasson, Marco Frontoni, Roberto Giorgianni, Paolo Girlanda, Licia Grazzi, Cristina Inglese, Ugo Leggio, Christian Lettieri, Paolo Liberini, Vitalma Liotti, Salvatore Lo Fermo, Silvia Lori, Alessandro Lozza, Loredana Maggi, Giorgio Maggioni, Edoardo Mampreso, Lucia Manzo, Roberta Marchese, Lucio Marinelli, Gabriele Masi, Eva Milano, Salvatore Misceo, Marcello Moccia, Maurizio Osio, Martina Petracca, Angelo Pascarella, Lorenzo Polidori, Renato Pozzolante, Maria Pia Prudenzano, Marcello Romano, Valentina Rossi, Simona Sacco, Grazia Sances, Antonio Santoro, Cesa Scaglione Lorella Maria, Vincenzo Sidoti, Paola Soliveri, Giovanna Maddalena Squintani, Nicola Tambasco, Carmen Terranova, Paola Torelli, Carlo Truscello, and Franco Valzania
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author.
Not applicable.