Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-18T13:53:36.152Z Has data issue: false hasContentIssue false
  • English
  • Français

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

Published online by Cambridge University Press:  14 September 2020

D Ioannidis ,
A Tsagkovits  and
A Rokade
D Ioannidis*
Affiliation:
ENT Department, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
A Tsagkovits
Affiliation:
ENT Department, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
A Rokade
Affiliation:
ENT Department, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
*
Author for correspondence: Mr D Ioannidis, ENT Department, Royal Hampshire County Hospital, Romsey Road, WinchesterSO22 5DG, UK E-mail: dimitris.ioannidis@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Endoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment.

Methods

The efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3–10 μm in the operating theatre environment.

Results

Aerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape.

Conclusion

The method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.

Keywords

Nasal Surgical Procedures AerosolsCoronavirus
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 9 , September 2020 , pp. 804 - 810
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr D Ioannidis takes responsibility for the integrity of the content of the paper

References

World Health Organization. Director-General's opening remarks at the media briefing on COVID-19–11 March 2020. In: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [15 May 2020]Google Scholar
Vukkadala, N, Qian, Z, Holsinger, F, Patel, Z, Rosenthal, E. COVID-19 and the otolaryngologist: preliminary evidence-based review. Laryngoscope 2020. Epub 2020 Mar 26Google ScholarPubMed
Givi, B, Schiff, B, Chinn, S, Clayburgh, D, Iyer, N, Jalisi, S et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg 2020;146:579–84CrossRefGoogle ScholarPubMed
Boccalatte, L, Larrañaga, J, Perez Raffo, G, Teijido, C, García Fornari, G, Staneloni, M et al. Brief guideline for the prevention of COVID-19 infection in head and neck and otolaryngology surgeons. Am J Otolaryngol 2020;41:102484CrossRefGoogle ScholarPubMed
Patel, Z, Fernandez-Miranda, J, Hwang, P, Nayak, J, Dodd, R, Sajjadi, H et al. Letter: Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 2020;87:E66–7CrossRefGoogle ScholarPubMed
Tran, K, Cimon, K, Severn, M, Pessoa-Silva, C, Conly, J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS ONE 2012;7:e35797CrossRefGoogle ScholarPubMed
Thompson, K, Pappachan, J, Bennett, A, Mittal, H, Macken, S, Dove, B et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic – the risk of aerosol generation during medical procedures. PLoS ONE 2013;8:e56278CrossRefGoogle ScholarPubMed
de Wit, E, van Doremalen, N, Falzarano, D, Munster, V. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14:523–34CrossRefGoogle ScholarPubMed
Xu, K, Lai, X, Liu, Z. Suggestions on the prevention of COVID-19 for health care workers in department of otorhinolaryngology head and neck surgery. World J Otorhinolaryngol Head Neck Surg 2020. Epub 2020 Apr 2CrossRefGoogle ScholarPubMed
Remuzzi, A, Remuzzi, G. COVID-19 and Italy: what next? Lancet 2020;395:1225–8CrossRefGoogle ScholarPubMed
Zou, L, Ruan, F, Huang, M, Liang, L, Huang, H, Hong, Z et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177–9CrossRefGoogle ScholarPubMed
Chen, J, Workman, A, Chari, D, Jung, D, Kozin, E, Lee, D et al. Demonstration and mitigation of aerosol and particle dispersion during mastoidectomy relevant to the COVID-19 era. Otol Neurotol 2020. Epub 2020 May 8CrossRefGoogle ScholarPubMed
Workman, A, Welling, D, Carter, B, Curry, W, Holbrook, E, Gray, S et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 2020;10:798–805CrossRefGoogle ScholarPubMed
Sharma, D, Rubel, K, Ye, M, Shipchandler, T, Wu, A, Higgins, T et al. Cadaveric simulation of endoscopic endonasal procedures: analysis of droplet splatter patterns during the COVID-19 pandemic. Otolaryngol Head Neck Surg 2020;163:145–50CrossRefGoogle ScholarPubMed
World Health Organization. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance, 6 April 2020. In: https://apps.who.int/iris/handle/10665/331695 [1 June 2020]Google Scholar
Coronavirus disease 2019 (COVID-19): infection control guidance. 2020. In: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-ecommendations.html [28 April 2020]Google Scholar
Morawska, L, Cao, J. Airborne transmission of SARS-CoV-2: the world should face the reality. Environ Int 2020;139:105730CrossRefGoogle ScholarPubMed
Morawska, L, Tang, J, Bahnfleth, W, Bluyssen, P, Boerstra, A, Buonanno, G et al. How can airborne transmission of COVID-19 indoors be minimised? Environ Int 2020;142:105832CrossRefGoogle ScholarPubMed
World Health Organization. Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care: WHO Guidelines. Geneva: WHO, 2014Google Scholar
Jenkins, A. Letter: Transmission of COVID-19 during neurosurgical procedures – some thoughts from the United Kingdom. Neurosurgery 2020;87:E68CrossRefGoogle ScholarPubMed
Adams, J, Walls, R. Supporting the health care workforce during the COVID-19 global epidemic. JAMA 2020;323:1439–40CrossRefGoogle ScholarPubMed
Lo, Y, Yang Teo, N, Ang, B. Editorial. Endonasal neurosurgery during the COVID-19 pandemic: the Singapore perspective. J Neurosurg 2020;133:26–8CrossRefGoogle Scholar
Rokade, A, Burgess, A, Ismail Koch, H, Tsagkovits, A, Ioannidis, D. FESS in the COVID era: the microscope drape method to reduce aerosolisation. ENT UK, 2020. In: https://www.entuk.org/fess-covid-era-microscope-drape-method-reduce-aerosolization [1 June 2020]Google Scholar
R Core Team. A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing, 2020Google Scholar
Seto, W. Airborne transmission and precautions: facts and myths. J Hosp Infect 2015;89:225–8CrossRefGoogle ScholarPubMed
Liu, Y, Ning, Z, Chen, Y, Guo, M, Liu, Y, Gali, N et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature 2020;582:557–60CrossRefGoogle ScholarPubMed
Jotz, G, Voegels, R, Bento, R. Otorhinolaryngologists and coronavirus disease 2019 (COVID-19). Int Arch Otorhinolaryngol 2020;24:e125–8Google Scholar
Iorio-Morin, C, Hodaie, M, Sarica, C, Dea, N, Westwick, H, Christie, S et al. Letter: The risk of COVID-19 infection during neurosurgical procedures: a review of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) modes of transmission and proposed neurosurgery-specific measures for mitigation. Neurosurgery 2020;87:E178–85CrossRefGoogle ScholarPubMed
World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. In: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations [1 June 2020]Google Scholar
Al-Jabir, A, Kerwan, A, Nicola, M, Alsafi, Z, Khan, M, Sohrabi, C et al. Impact of the coronavirus (COVID-19) pandemic on surgical practice - Part 2 (surgical prioritisation). Int J Surg 2020;79:233–48CrossRefGoogle Scholar
ENT UK guidelines for changes in ENT during COVID-19 pandemic. In: https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19-pandemic [1 June 2020]Google Scholar
van Doremalen, N, Bushmaker, T, Morris, D, Holbrook, M, Gamble, A, Williamson, B et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564–7CrossRefGoogle ScholarPubMed
Mick, P, Murphy, R. Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review. J Otolaryngol Head Neck Surg 2020;49:29CrossRefGoogle ScholarPubMed
Guo, Z, Wang, Z, Zhang, S, Li, X, Li, L, Li, C et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. J Emerg Infect Dis 2020;26:1583–91CrossRefGoogle Scholar
American Academy of Otolaryngology-Head and Neck Surgery. Academy Supports CMS, Offers Specific Nasal Policy. In: https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy [25 May 2020]Google Scholar
Matava, C, Yu, J, Denning, S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth 2020;67:902–4CrossRefGoogle ScholarPubMed
Wang, W, Xu, Y, Gao, R, Lu, R, Han, K, Wu, G et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323:1843–4Google ScholarPubMed