COVID-19 TRANSMISSION
Wondering if breastfeeding is risky
One of my patients, who is 9 months pregnant, just tested positive for SARS-CoV-2 although she is not experiencing any symptoms. She had been planning to breastfeed but now she is worried about transmitting the infection to the infant. Of course I told her to discuss her concerns with her provider, but now I am wondering-has any research on this emerged yet?-P.V., DEL.
Although the issue has not yet been well studied, one encouraging report suggests that women with COVID-19 can safely breastfeed their infants. The three-month study involved 55 infants born to mothers who were positive for SARS-CoV-2 and separated at birth from their mothers. All of these infants were screened for infection within 48 hours of birth, and all tested negative.
Most of the infants (74.5%) were fed unpasteurized expressed breast milk during the postpartum separation period until discharge. At discharge, most of the mothers were instructed about anti-infection measures.
Rescreening took place 14 days or more after discharge. Data regarding SARS-CoV-2-positive household members and breastfeeding were obtained by follow-up phone calls. About 40% of households contained additional SARS-CoV-2-positive residents, and 85% of the infants were breastfed at home.
Sixty percent of the infants were retested for SARS-CoV-2 after discharge. All of these tests were negative.
The authors write, "These findings may provide insights regarding the redundancy of postpartum mother-newborn separation in SARS-CoV-2-positive women and, assuming precautions are adhered to, support the safety of breast milk."
Source: Schomai NO, Kasirer Y, Strauss T, et al. Neonatal SARS-CoV-2 infections in breastfeeding mothers. Pediatrics. 2021; 147(4).
PENICILLIN ALLERGY
Is cefazolin safe for pre-op prophylaxis?
Although one of my patients who recently underwent surgery had reported a possible penicillin allergy, her surgeon prescribed cefazolin for preoperative prophylaxis. She experienced no adverse reactions to the drug. I was taught that patients with penicillin allergies should avoid cefazolin and other cephalosporins because of the risk of cross-reactivity. Has something changed?-N.M., R.I.
Emerging evidence suggests that the common practice of avoiding cefazolin in patients with a penicillin allergy may be outdated. The practice is grounded in research from the 1960s and 1970s that reported a cross-reactivity rate of 8% between penicillins and cephalosporins such as cefazolin. However, researchers who recently conducted a meta-analysis of 77 studies involving 6,147 patients found only 44 patients who were identified as allergic to a natural penicillin and cefazolin, resulting in a meta-analytical frequency of just 0.7%.
Cefazolin is the preoperative antibiotic of choice because it is safer and more effective than second-line alternatives such as clindamycin or vancomycin. Not only are these alternatives more expensive, they are also associated with higher rates of surgical site infections. Based on these study findings, the researchers write that "the low frequency of penicillin-cefazolin dual allergy suggests that most patients should receive cefazolin regardless of penicillin allergy history."
Sources: Sousa-Pinto B, Blumenthal KG, Courtney L, Mancini CM, Jeffres MN. Assessment of the frequency of dual allergy to penicillins and cefazolin: a systematic review and meta-analysis. JAMA Surg. 2021;156(4):e210021. Massachusetts General Hospital. Common antibiotic can safely be given to most surgery patients despite penicillin allergy. News release. March 17, 2021.
HIPAA PRIVACY RULE
Overheard at the nurses' station
During a recent patient emergency, several providers and nurses gathered at the nurses' station to exchange information about the patient's condition. I felt uneasy because passers-by could have easily overheard confidential patient information. Does such an incident violate the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA)?-C.D., OHIO
No. Guidelines from the US Department of Health and Human Services (HHS) state that although clinicians must implement reasonable precautions to protect privileged information, inadvertent disclosures may be unavoidable in some circumstances such as the emergency you describe. The HIPAA Privacy Rule recognizes that conversations must often occur quickly in treatment settings and is not intended to inhibit clinicians from talking with each other or with their patients.
Examples of reasonable precautions for preventing inadvertent disclosures include lowering the voice or standing apart from others when sharing information if circumstances permit. However, the priority is patient care, and clinicians are "free to engage in communications as required for quick, effective, and high-quality healthcare," according to HHS guidelines.
Assuming that reasonable precautions are taken, the HIPAA Privacy Rule permits the following:
* Healthcare staff may orally coordinate services at hospital nursing stations.
* Nurses and other healthcare professionals may discuss a patient's condition over the phone with the patient, a provider, or a family member.
* A healthcare professional may discuss lab test results with a patient or other provider in a joint treatment area.
* A provider may discuss a patient's condition or treatment regimen in the patient's semiprivate room.
* Healthcare professionals may also discuss a patient's condition during training rounds in an academic or training institution.
* A pharmacist may discuss a prescription with a patient over the pharmacy counter, or with a physician or the patient over the phone.
Source: US Department of Health and Human Services. HIPAA FAQs for professionals. http://www.hhs.gov/hipaa/for-professionals/faq/index.html.