In-vitro evaluation of surgical helmet systems for protecting surgeons from droplets generated during orthopaedic procedures

Wendlandt, Robert; Thomas, Mareena; Kienast, B.; Schulz, Arndt P.

doi:10.1016/j.jhin.2016.05.002

Cited by 21 publications

(15 citation statements)

References 20 publications

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“…It is imaginable that regular surgical helmets could be modified with proper filters to achieve sufficient FE. The protective ability of surgical hoods to safeguard the surgeon against exposure to infectious bodily fluids and direct transfer of microorganisms or particulate matter has been verified in vitro (Wendlandt et al 2016). The hood on the Flyte Personal Protection System provides leading-class AAMI/ANSI Level 4 protection (Association for Advancement of Medical Instrumentation/American National Standards Institute); nevertheless, the top of the hood that the air passes through is not designed to filter aerosols.…”

Section: Discussionmentioning

confidence: 99%

Does a surgical helmet provide protection against aerosol transmitted disease?

2020

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Background and purpose — The COVID-19 pandemic caused by infection with SARS-CoV-2 has led to a global shortage of personal protective equipment (PPE). Various alternatives to ordinary PPE have been suggested to reduce transmission, which is primarily through droplets and aerosols. For many years orthopedic surgeons have been using surgical helmets as personal protection against blood-borne pathogens during arthroplasty surgery. We have investigated the possibility of using the Stryker Flyte surgical helmet as a respiratory protective device against airborne- and droplet-transmitted disease, since the helmet shares many features with powered air-purifying respirators. Materials and methods — Using an aerosol particle generator, we determined the filtration capacity of the Stryker Flyte helmet by placing particle counters measuring the concentrations of 0.3, 0.5, and 5 µm particles inside and outside of the helmet. Results — We found that the helmet has insufficient capacity for filtrating aerosol particles, and, for 0.3 µm sized particles, we even recorded an accumulation of particles inside the helmet. Interpretation — We conclude that the Stryker Flyte surgical helmet should not be used as a respiratory protective device when there is a risk for exposure to aerosol containing SARS-CoV-2, the virus causing COVID-19, in accordance with the recommendation from the manufacturer

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Section: Discussionmentioning

confidence: 99%

Does a surgical helmet provide protection against aerosol transmitted disease?

2020

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“…Outside the purview of dentistry, droplet infection transmission from surgical procedures and surgical instruments has been researched much more frequently in relation to human immunodeficiency virus (HIV) transmission and the transmission of iatrogenic wound infections [ 22 - 26 ]. Although direct surgical trauma and inoculation accounts for up to 75% of healthcare worker transmission [ 10 ], the transmission risk of airborne infection from infected hosts to recipients is still reported and evidenced for a variety of pathogens such as Mycobacterium tuberculosis, Staphylococcus aureus, Legionella, Varicella-zoster virus, Variola virus , and influenza virus A [ 22 , 27 - 30 ]. Viruses have been reported to survive in the surgical smoke created by electrosurgical instruments [ 26 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite the numerous recent publications focusing on aerosol generation from surgical procedures, two aspects remain unclear: (1) whether this “respiratory-transmitted pathogen” has a proportionate viral load in the bloodstream, which could cause viral transmission via blood and/or blood-aerosols; and (2) whether surgical procedures can generate such blood-aerosols to potentially incite viral transmission. Orthopedic surgeons are recognized as having the highest risk of occupational exposure to a patient’s blood in the form of aerosol inhalation or direct splatter [ 10 ]. Aerosolization of virus-laden blood particles could represent an additional risk for surgical teams in these trying times.…”

Section: Introductionmentioning

confidence: 99%

Coronavirus Disease 2019 Transmission: Blood Viremia and Aerosol Generation from Spinal Surgery. Is There an Increased Risk to the Surgical Team?

et al. 2020

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As a respiratory pathogen, the novel coronavirus is commonly associated with aerosol-generating procedures. However, it is currently unclear whether spinal surgical procedures pose an additional risk of viral transmission to the surgical team. We reviewed the available evidence to ascertain the presence of coronavirus disease 2019 (COVID-19) blood viremia and the virus’ blood transmissibility, as well as evidence of blood-aerosol generation and operating room contamination from spinal surgical procedures. There is established evidence of COVID-19 blood viremia, a viral pathogenic cycle via angiotensin-converting enzyme 2 (ACE-2) receptors and similar blood transmission risk data from the SARS (severe acute respiratory syndrome)/MERS (Middle East respiratory syndrome) era. Spinal surgical practices demonstrate significant blood-aerosol generation from the operative wound due to the use of common surgical instruments, such as electrocautery, as well as high-speed and high-impact devices. Based on the evidence, there is an established additional risk of viral transmission faced by surgical teams from blood-aerosols generated from the operative wound of COVID-19- infected patients via the inhalation of virus-laden aerosols and the subsequent initiation of the viral pathogenic cycle through binding with pulmonary ACE-2 receptors. Recognizing this additional risk amidst the ongoing pandemic serves as a caution to front-line surgical personnel to strictly adhere to personal protective equipment usage in operating rooms, to modify surgical techniques to reduce the hazard of surgical aerosol generation and COVID-19 viral exposure, and to consider it as an integral aspect of planning and adapting to the “new normal” operating practices.

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“…Body exhaust suits are widely used in orthopedic procedures and may protect the surgical team from contamination [47]; however, their utility for infection prevention remains controversial [43,48]. The recent CDC guidelines leave this issue unresolved, and recent studies fail to show any benefit in reducing SSI or PJI [21,49,50].…”

Section: Personal Protection Suitsmentioning

confidence: 99%