Purpose To provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era. Methods We have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model. Results The pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization. Conclusions The mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke. Electronic supplementary material The online version of this article (10.1007/s00405-020-06462-1) contains supplementary material, which is available to authorized users.

Introducción: Durante la pandemia COVID-19 es necesario que los profesionales actualicen conocimientos, actitudes y habilidades para tratar la infección, y se protejan frente al contagio con suministros sanitarios limitados. Se describe el empleo estratégico de un centro de simulación para facilitar la adaptación de un servicio de salud a la pandemia. Métodos: Se analiza la experiencia de un centro de simulación en Cantabria, España. Un grupo de trabajo identifica y clasifica las necesidades en tres áreas: 1) aprendizaje (categorizadas con un sistema de zonas para adaptar el diseño e implementación del entrenamiento a las necesidades específicas); 2) innovación (relacionadas con la práctica asistencial y el equipamiento sanitario); y 3) suministros sanitarios (que pueden fabricarse con las impresoras 3D disponibles en el centro de simulación para material docente). Resultados: 1) Se implementan tres tipos de actividades de entrenamiento: talleres de formación de formadores para protección frente a trasmisión por gota-contacto, simulaciones para la protección frente a contagio por aerosoles y un marco de trabajo para el análisis de las situaciones con pacientes reales. 2) Se analizan máscaras de buceo para asistencia ventilatoria, prototipos de ventiladores y técnicas para ventilar dos pacientes con un ventilador. 3) Se fabrican máscaras de protección facial, hisopos para la toma de muestras y horquillas para mascarillas. Conclusión: La participación estratégica de un centro de simulación puede promover y facilitar la adaptación de un sistema de salud a una epidemia por COVID-19.

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Background and objective There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. Methods A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. Results The following supplies are produced: 1) devices that help protect providers: face protection screens (2400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. Conclusions 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.

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