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

Abstract

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.

Union of the European Phoniatricians’ position statement on the exit strategy of phoniatric and laryngological services: staying safe and getting back to normal after the peak of coronavirus disease 2019 (issued on 25th May 2020)

“…2 As a poignant example, the first documented death of a physician was that of an ENT surgeon in Wuhan, China, on 25th January 2020. 3 This increased risk is due in part to exposure to aerosol generation, 4 a result of the presence of the virus in the nasal and pharyngeal cavities of infected individuals. Viral load has been noted to be higher in the nose than the throat.…”

Otolaryngology Surgical Activity in Tertiary Care Center During the Covid-19 Lockdown

“…A number of other Aerosol Generating Procedures were performed during this period which includes endoscopic removal of foreign body from nose, Endoscopic skull base surgery for JNA, Micro laryngeal Posterior cordotomy for bilateral abductor palsy, laryngeal/ hypopharyngeal biopsy and oral biopsy. To prevent further risk of aerosol generation instruments like CO2 laser, Electrocautry, high speed rotating devices were not used and hence conventional techniques were employed [20].…”

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

“…[36][37][38][39][40][41][42][43][44][45] Care of tracheostomy attached to a closed-circuit ventilatory system is considered to be a low-risk AGP; however, when the circuit is disconnected for suctioning, nebulization of medication, or tracheostomy tube change, they are considered high-risk AGPs ( Table 1). 32,46,47 Tracheostomy increases risk of aerosolization because of the shorter distance from the high-viral density alveolar surface to the stoma. 3 The amount of care that patients with a tracheostomy require increases the duration of exposure, and accumulation of secretions around the stoma places clinicians at close contact with infected fluids, increasing risk of transmission.…”