3) Use of Personal Protective Equipment
Personal Protective Equipment (PPE) is a precious resource in major
disease outbreaks. As otolaryngologists are at high risk of contact with
respiratory droplets or aerosolized upper airway particles, the need for
a sustainable and evidence-based PPE usage guideline was of paramount
importance.
There is currently no international consensus on the best method of
reducing the risk of virus transmission. In our department, the
following was implemented at the initial phase of the outbreak:
- In outpatient clinics, a surgical mask was required for all patient
encounters. If a nasoendoscopy was to be performed, a fitted N95 mask
and eye protection (either faceshield or surgical goggles) were to be
worn.
- In operating theatres, a surgical mask was required for all surgeries.
If the surgery involved mucosa of the upper airway, a fitted N95 mask
and eye protection were to be worn. For any surgery involving
confirmed COVID-19 cases, a Powered Air-Purifying Respirator (PAPR)
was to be worn.
As the outbreak intensified and medical literature expanded, debates on
the type of PPE required grew. In the tenth week of the outbreak, after
discussion with Infectious Disease specialists, the department
guidelines were modified to:
- In outpatient clinics, a surgical mask was required for all patient
encounters. If a nasoendoscopy was to be performed, a shower cap,
water-resistant gown, N95 mask and eye protection were to be worn.
- In operating theatres, a surgical mask and eye protection were
required for all surgeries. For any surgery involving mucosa of the
upper airway, minimum requirement included N95 mask and eye
protection, regardless of the patient’s COVID-19 status. PAPRs were
available for surgeons who felt more comfortable donning them.
Functional PAPR units are available in our institution since the SARS
outbreak, and further acquisition is underway. A coordinated effort
was made to ensure that daily surgery listing did not exceed the
availability of PAPRs.
- At the time of writing, routine pre-operative COVID-19 testing for all
patients is not available in our institution. We are constantly
reviewing our guidelines to ensure sustainable use of minimum PPE and
PAPR for surgeon safety.