An avoidable occupational hazard during mastoid surgery

Lannigan, Francis J.; Jones, N S; Schoenberg, M. V. von

doi:10.1017/s002221510010934x

Cited by 7 publications

(8 citation statements)

References 4 publications

(3 reference statements)

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“…This is in agreement with our prior analysis of droplet spread during mastoidectomy, in which cadaveric tissue was detected 6 ft from the surgical site 12 . In a separate study, the spread of particulates generated during mastoidectomy was noted at a maximum of 41 cm away 22 . Together with the current study, there is evidence of both droplet spread and aerosol generation during mastoidectomy, but no direct evidence for SARS‐CoV‐2 transmission.…”

Section: Discussionsupporting

confidence: 91%

Aerosol generation during cadaveric simulation of otologic surgery and live cochlear implantation

Sharma

Campiti

et al. 2020

Laryngoscope Investig Oto

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Objective The risk of SARS‐CoV‐2 transmission to healthcare workers through airborne aerosolization during otologic surgery has not been characterized. The objective of this study was to describe and quantify the aerosol generation during common otologic procedures in both cadaveric surgical simulation and live patient surgery. Methods The number concentrations of generated aerosols in the particle size range of 0.30 to 10.0 μm were quantified using an optical particle sizer during both a cadaveric simulation of routine otologic procedures as well as cochlear implant surgery on live patients in the operating room. Results In the cadaveric simulation, temporalis fascia graft harvest using cold techniques (without electrocautery) (n = 4) did not generate aerosols above baseline concentrations. Tympanoplasty (n = 3) and mastoidectomy (n = 3) both produced statistically significant increases in concentrations of aerosols (P < 0.05), predominantly submicron particles (< 1.0 μm). High‐speed, powered drilling of the temporal bone during mastoidectomy with a Multi Flute cutting burr resulted in higher peak concentrations and greater number of spikes in aerosols than with a diamond burr. In the operating room, spikes in aerosols occurred during both cochlear implant surgeries. Conclusion In the cadaveric simulation, temporalis fascia graft harvest without electrocautery did not generate aerosol levels above baseline, while significant aerosol levels were generated during mastoidectomy and to a much less degree during tympanoplasty. Aerosol spikes were appreciated during cochlear implantation surgery in live patients. Level of Evidence 2.

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Section: Discussionsupporting

confidence: 91%

Aerosol generation during cadaveric simulation of otologic surgery and live cochlear implantation

Sharma

Campiti

et al. 2020

Laryngoscope Investig Oto

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“…There was significant heterogeneity among the three studies and only one study was deemed clinically relevant and of adequate quality [49]. The three studies were found describing aerosolization of bone dust and contaminated irrigation fluid (Table 9) [49][50][51]. Aggregated Evidence: Grade D: three experimental studies.…”

Section: Mastoid Surgerymentioning

confidence: 99%

Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID-19 pandemic

Thamboo

Lea

Sommer

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

120

135

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Background: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology -Head and Neck Surgery and provide evidence-based recommendations.Methods: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category.Results: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. Conclusions: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

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“…Theatre nurses are likely to be at less risk than surgeons since they are generally further from the operative field. However, Lannigan et al (1989) have demonstrated that irrigation fluid during temporal bone dissection may spread up to 41 cm from the point of drilling and we have noticed splashes on the theatre nurse's spectacles following mastoid surgery. We will be investigating this further in order to determine how frequently such contamination occurs.…”

Section: Eye Protectionmentioning

confidence: 96%

“…The Department of Health (1990) recommended that the mucous membranes of the eyes, mouth and nose should be protected from blood splashes and the Joint Working Party of the Hospital Infection Society and the Surgical Infection Study Group (1992) advised that extra precautions including eye protection should be taken when operating on patients known to be hepatitis B or HIV positive and in 'high risk' cases including orthopaedic procedures involving power tools. Recent articles have supported these recommendations (Lannigan et al, 1989;Prior et al, 1993).…”

Section: Eye Protectionmentioning

confidence: 98%