2.3 Adjunctive techniques
Other groups have considered more novel applications to mitigate risk. Three studies tested the fitment of a specific mask on the patient.16,18,28 All such work was performed in simulated settings and considered droplet spread in terms of splatter evaluated through fluorescent tracing with fluorescein. Viera-Artiles et al. (2020)28 and Helman et al. (2020)18 used 3-D printed mask designs and evaluated droplet dispersal following endonasal high-speed drill use. Whilst both studies noted a reduction in droplet detection, neither prevented droplet aerosolisation completely. Jones et al. (2020)16 added suction beneath their patient mask to create a negative pressure environment finding that droplet spread was eliminated during cadaveric sinus surgery simulations using both the microdebrider and high-speed drill. Though encouraging, this work does not consider aerosolisation of smaller particles.
Five very similar feasibility studies report on their experience of specific patient draping.29-33 The majority employ a polythene sheet, under which the surgeon operates.29-32 Of these, only Arefin et al. (2021)29 published outcomes, reporting no COVID-19 infections amongst twelve theatre team members over a five-month period. Both Ioannidis et al. (2020)34 and David et al. (2020)35 also draped the patient in a polythlene sheet but, in a similar strategy to Jones et al. (2020)16above, attached suction to create a negative pressure environment. Ioannidis et al. (2020)34 considered the aerosolisation of small particles, simulated with a smoke generator in a plastic manikin. An OPC (Fluke 985; Fluke Co., USA) was used to measure particles 0.3-0.5μm which were still detected outside of their drape system, albeit at reduced levels. Similarly, David et al. (2020)35 found that fluorescein droplets continued to be noted outside of their draping in two of four patients evaluated.