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  • 1. Drape Application
  • 2. Drape Demostration
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Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic

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C. Scott Brown, MD1; Paulo Dominaitis, CST2; Fred F. Telischi, MEE, MD, FACS1
1 University of Miami Miller School of Medicine
2 Bascom Palmer Eye Institute

Main Text

Table of Contents

  1. Case Overview
  2. Citations

Coronavirus disease (COVID-19) has emerged as a worldwide pandemic, profoundly impacting healthcare systems. Otolaryngologists have confronted significant challenges amid the COVID-19 outbreak, given the heightened risk of infection due to occupational exposure.1,2 Despite the use of personal protective equipment, concerns remain over the potential transmission of SARS-CoV-2. This is owing to the virus's capability to remain alive and infectious in aerosols for extended periods of time, as well as on surfaces for several days.3 Transmission occurs via respiratory droplets and aerosolized virus particles, which are generated during specific interventions such suctioning, bone drilling, and the application of diathermy. The mastoid and middle ear mucosa are connected to the nasopharyngeal mucosa and can serve as a potential source of viral particles in an infected patient. This highlights the need for the development and implementation of strategies that minimize aerosol spread.

Mastoidectomy, a surgical procedure to remove infected mastoid air cells, is identified as an aerosol-generating procedure, which raises concerns. Existing studies highlight that the use of high-powered drills is associated with generation of aerosol and small particles capable of transmitting infectious diseases.4 The presented video introduces an innovative approach to mitigate the dissemination of circulating aerosols in the operating room. This involves creating a protective tent using a surgical microscope drape and establishing a barrier cover that prevents aerosol from spreading, thereby promoting a safer surgical environment and diminishing viral exposure. The technique involves a centrally cut hole to accommodate the microscope lens, with the drape's adhesive securing it around the scope aperture, ensuring an unobstructed line of sight. To prevent contamination during hand movements beneath it, the bottom edge of the drape is trimmed. As shown in a recent study by Chen et al, this straightforward yet effective solution involving the use of a barrier drape significantly reduces particulate matter dispersion during mastoidectomy, providing evidence for the effectiveness of the proposed method.5

The method proposed in this video offers a practical and innovative means of enhancing the safety of operating room personnel during mastoidectomy. Beyond its immediate application, this approach serves as a model for infection control, holding promise for broader implementation in diverse healthcare settings struggling with the ongoing challenges of the COVID-19 pandemic.

Citations

  1. Sowerby LJ, Stephenson K, Dickie A, et al. International registry of otolaryngologist–head and neck surgeons with COVID-19. Int Forum Allergy Rhinol. 2020;10(11). doi:10.1002/alr.22677.
  2. Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk factors of healthcare workers with coronavirus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis. 2020;71(16). doi:10.1093/cid/ciaa287.
  3. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. NEJM. 2020;382(16). doi:10.1056/nejmc2004973.
  4. Hual A, Walshe P, Gendy S, Knowles S, Burns H. Mastoidectomy and trans-corneal viral transmission. Laryngoscope. 2005;115(10 I). doi:10.1097/01.mlg.0000177459.80574.2d.
  5. Chen JX, Workman AD, Chari DA, et al. Demonstration and mitigation of aerosol and particle dispersion during mastoidectomy relevant to the COVID-19 era. Otol Neurotol. 2020;41(9). doi:10.1097/MAO.0000000000002765.