Operative Field Debris Often Rises to the Level of the Surgeon's Face Shield During Spine Surgery: Are Orthopedic Space Suits a Reasonable Solution?

Abstract

Background: The present study intended to identify debris in the spine surgical field that frequently rises to the level of the surgeon's face during several different elective spine procedures. Unlike other areas of orthopedic surgery where infection risk is of high concern, in spine surgery the surgical team usually uses a nonsterile face mask instead of a protective space suit with a sterile face shield. It is possible that blood or bone burr particles striking the surgeon's face mask represent a potential source of infection if they ricochet back into the operative field. Methods: We reviewed 46 consecutive, elective spine surgeries between May 2015 and August 2015 from a singlesurgeon practice. For each surgery, every member of the surgical team wore sterile (space suit) personal protective equipment. After each procedure, the face shield was carefully inspected by 2 members of the surgical team to identify patient blood, tissue, or bone burr dust present on the face shield. Results: The rate of surgeon face shield debris inspected for each case overall was 38/46 (83%). The rate of first assistant face shield debris inspected per case was 16/46 (35%). The scrub technician had a 0% rate of face mask debris on inspection. The highest debris exposure rates occurred with transforaminal lumbar interbody fusions (100%), open laminectomy and fusions (100%), and anterior cervical discectomy and fusions 43/46 (93%). Conclusions: There is a high rate of blood and tissue debris contact that occurs during spine surgery, and it is procedure dependent. Spine surgeons may consider using sterile shields particularly in high-risk cases to protect themselves and their patients. Level of Evidence: 4.

Are facemasks a priority for all staff in theatre to prevent surgical site infections during shortages of supply? A systematic review and meta-analysis

“…Aside from the benefits in preventing infection, surgical facemasks also protect the staff members from contamination from the fluid splashes and debris during surgery. 43 , 44 , 45 An additional benefit is the potential impact on surgical discipline. This is a sequence of routines that may not have an individual benefit on infection rates, but as a package contribute to improved theatre behaviours known to impact infection such as number of door openings and numbers of persons in a theatre.…”

The effectiveness and compliance of surgical face mask wearing in the operating suite environment: An integrated review

“…Cook et al conducted an experimental study during spinal surgery (n = 46) and reported debris was highest on the surgeons' face shield (83%) followed by the first assistant (35%) and scrubbed technician/nurse (0%) 24 . Moreover, debris was identified more in procedures where aggressive instruments were used such as a burr, osteotome or an interbody cage.…”

“…Moreover, debris was identified more in procedures where aggressive instruments were used such as a burr, osteotome or an interbody cage. The research by Cook et al was limited to spinal surgery 24 ; however, it has been shown that all types of surgery have some degree of risk of splash associated with them, and laparoscopic surgery shows a higher risk of splash particularly when the pneumoperitoneum is decompressed 19 . Therefore, scrubbed staff, especially surgeons, would benefit from using a surgical mask during surgery as part of normal PPE.…”

“…• discuss the implications of a higher airborne biological load with the perioperative team 13,14 • understand that face masks lower the biological load for bearded men 15 • realise that face masks should be worn correctly and changed every two hours and after each case 17,19,20 • ensure all perioperative staff and students in the OR are always made aware of the possibility of blood spray reaching both scrubbed and non-scrubbed team members and the importance of wearing appropriate PPE 19,24,25 • speak slowly and clearly when wearing a face mask because of the impact of face masks on speech intelligibility 23…”

“…1. wearing surgical face masks is a vital part of PPE, providing staff with protection from blood and body fluid splash 19,24,25 2. wearing a face mask decreases the biological load in the theatre environment 13,14 .…”