Procedural precautions and personal protective equipment during head and neck instrumentation in the COVID‐19 era

Abstract

Background: Otolaryngologists represent a subset of health care workers uniquely vulnerable to COVID-19 transmission. Given the segmentation of extant guidelines concerning precautions and protective equipment for SARS-CoV2, we aimed to provide consolidated recommendations regarding appropriate personal protective equipment (PPE) in head neck surgery during the COVID-19 era. Methods: Guidelines published by international and US governing bodieswere reviewed in conjunction with published literature concerning COVID-19 transmission risk, testing, and PPE, to compile situation-specific recommendations for head and neck providers managing COVID-19 patients. Results: High-quality data regarding the aerosolization potential of head and neck instrumentation and appropriate PPE during head and neck surgeries are lacking. However, extrapolation of recommendations by governing bodies suggests strongly that head and neck mucosal instrumentation warrants strict adherence to airborne-level precautions. Conclusion: We present a series of situation-specific recommendations for PPE use and other procedural precautions for otolaryngology providers to consider in the COVID-19 era.

Review of indoor aerosol generation, transport, and control in the context of COVID‐19

“…The lack of studies within the otorhinolaryngology field assessing the aerosol‐generating potential of procedures involving mucosal surfaces pre‒COVID‐19 made it challenging to understand in an evidence‐based fashion the potential risks of SARS‐CoV‐2 transmission associated with instrumentation of the upper airway; that is, whether these procedures may be infectious AGPs. At the early stages of the pandemic, based on the risks of exposure to high viral load mucosal surfaces, 10,11 as well as on the lack of any immunity to SARS‐CoV‐2 and of any vaccines or effective treatments, an array of practice changes to protect health‐care workers and patients were recommended and instituted for otorhinolaryngology procedures involving upper airway mucosal surfaces 9,12‐17 …”

Das erste Jahr der Pandemie mit SARS-CoV-2 – Auswirkungen auf die Hals-Nasen-Ohren-Heilkunde

“…Für den Bereich der Hals-Nasen-Ohren-Heilkunde wird für die folgenden Tätigkeiten ein erhöhtes Risiko durch Aerosolexposition vermutet oder wurde bereits nachgewiesen. Allgemeine Hals-Nasen-Ohren-ärztliche Untersuchung Für die Untersuchung der oberen Luftwege wird ein erhöhtes Infektionsrisiko mit SARS-CoV‑2 beschrieben [ 14 , 30 , 35 ]. Insbesondere bei der starren oder flexiblen Endoskopie der Nase, des Nasenrachenraums, des Oro‑/Hypopharynx und des Larynx wird von einer Aerosolbildung ausgegangen[ 18 , 38 ].…”

Respiratory Particle Emission During Voice Assessment and Therapy Tasks in a Single Subject

“…Medical procedures that increase exposure to respiratory droplets or aerosols have been identified as high-risk for disease transmission. Otolaryngologists and speech-language pathologists by nature of their professions are believed to provide a number of high-risk procedures including aerosol-generating surgeries, 1 , 2 , 3 outpatient nasal and laryngeal endoscopy, 1 , 4 , 5 dysphagia assessment and treatment, 6 and tracheostomy and voice prosthesis management. 7 Concerns and guidelines have been published and regularly updated for such services.…”