Povidone Iodine ‘WET’ technique: Adenotonsillectomy in COVID era
Key Points
Most of the ENT surgeries are aerosol generating procedures and pose a risk of infection to health care workers.
Povidone-iodine irrigation has been used in surgery and has proven to reduce surgical site infection.
Povidone iodine has good virucidal action even in low concentrations.
The novel technique of wet tonsillectomy with povidone iodine flush would possibly reduce the viral load.
This technique, in adjunct to other safety measures and personal protective equipment, could be a safe way to restart elective oral, ear and nasal procedures in asymptomatic patients during the pandemic.
COVID 19 pandemic has significantly changed ENT Practice. Most elective ENT (Ear, Nose, Throat) surgeries possess a risk of infection, as well as potentially increasing complication (1). With the current pandemic slowly evolving and ever-increasing demand for elective services to restart, service delivery with minimal risk to healthcare workers is a challenge. ENT procedures like Adenotonsillectomy, Microdebrider FESS and Mastoidectomy and many more are aerosol generating procedures. Adenotonsillectomy is particularly challenging with high risk to the operating room personnel as the viral load is significantly high in the nasopharynx and oropharynx. Evidence from China shows us that the pandemic could last for at least six months(2) and modifications of techniques and adapting to the new norm is the key.
Some countries are now considering RTPCR as routine. The sensitivity of the test is questioned with false negative rate of up to 30%(3)It is therefore imperative to be cautious even in patients who are RTPCR negative. We propose a technique of ‘WET’ (wash every time) adenotonsillectomy with povidone iodine wash to minimise the viral load, if any, to healthcare workers while performing adenotonsillectomy surgery.