‘POLIDON’ Approach—A Novel Solution for the ENT & Skull Base Surgeons in COVID-19 era

Abstract

Health care providers (HCP) of ENT and Skull base surgery are highly vulnerable and mostly infected by novel coronavirus as they have to examine and perform procedures directly in oral cavity, oropharynx, nose, nasopharynx, where coronavirus remains in plenty. ENT & Skull base surgeons need to do several aerosol generating procedures (AGP). Most of the endoscopic and microscopic ENT & skull base surgery are AGP; like-mastoid surgery, sinus surgery, surgery of pituitary, tympanomastoid paraganglioma, temporal bone malignancy, tracheostomy etc. All of we know, COVID negative by RT-PCR test is not always COVID negative. In COVID-19 pandemic-routine, even cancer surgeries are avoided or postponed for the sake of safety of HCPs. Moreover, in case of surgical emergency there's no way to refuse a patient for not having a report of COVID test. We thought about neutralizing or destroying the novel coronavirus from it's route of entry zone, as well as preventing aerosol to be transmitted in the air of OT. We designed a novel approach, i.e. 'POLIDON' (POLIDON = Polythene ? Povidone Iodine), which can be the solution for these patients as well as surgeons or HCPs of above mentioned specialties. Use of Povidone Iodine as mouthwash and nasal spray or irrigation for both patient and HCPs prior to surgery is proposed. Then, use of simple polythene as barrier drape of patient or operative area for prevention of spread of aerosol in OT during surgery is the other component. With the POLIDON' approach-all these ENT & skull base surgeries can be done with more safety and confidence.

COVID-19 - Mouthwash in dental clinical practice: review

“…Arefin et al 28 reported a new approach combining polyethylene protection fields with PVP-Ibased mouthwashes. According to the authors, both health professionals and patients should perform preoperative mouthwashes with 10 mL of 1% PVP-I solution, for 1 minute.…”

Povidone Iodine (PVP-I) Oro-Nasal Spray: An Effective Shield for COVID-19 Protection for Health Care Worker (HCW), for all

“…Since May 2020 I have attended more than 7000 patient in OPD and emergency, performed 501 endoscopy of larynx and nose (FOL, DNE) and 203 surgeries, including tracheostomy, mastoidectomy, endoscopic sinus surgery, skull base surgery, laryngeal biopsy, tonsillectomy, septoplasty etc. These are airway surgeries and moreover, most of them are aerosol generating procedures) [ 12 , 13 , 14 ].…”

“…Interestingly, among twelve different health care providers, including doctors, nurses and OT staffs, directly involved and exposed in these two surgeries, none of them were infected. Importantly, ‘POLIDON’ approach was followed in both the procedures [ 12 , 14 ].…”

One year into the COVID-19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

“…Five very similar feasibility studies report on their experience of specific patient draping. [29][30][31][32][33] The majority employ a polythene sheet, under which the surgeon operates. [29][30][31][32] Of these, only Arefin et al (2021) 29 published outcomes, reporting no COVID-19 infections amongst twelve theatre team members over a fivemonth period.…”

“…[29][30][31][32][33] The majority employ a polythene sheet, under which the surgeon operates. [29][30][31][32] Of these, only Arefin et al (2021) 29 published outcomes, reporting no COVID-19 infections amongst twelve theatre team members over a fivemonth 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) 16 above, attached suction to create a negative pressure environment.…”