Rhinologic Procedures in the Era of COVID-19: Health-care Provider Protection Protocol

Abstract

Introduction: SARS-CoV-2 has been identified as the pathogen causing the outbreak of Coronavirus Disease 2019 that started in Wuhan, China, in December 2019. SARS-CoV-2 has human-to-human transmission ability and universally contagious to all populations. The main transmission patterns are respiratory droplets transmission and contact transmission. The purpose of this study is to propose a protocol that may be used as a guide to reduce the incidence of COVID-19 infections among otolaryngology care teams. Methods: A prospective cohort study was conducted to show the efficacy of our protocol to prevent transmission to health-care providers from March 11, 2020 through April 14, 2020. The protocol consisted of a series of protective measures that we applied to all health-care providers, then testing of our providers for COVID-19 using reverse transcription polymerase chain reaction along with immunoglobulin M (IgM) and immunoglobulin G (IgG) testing at the end of the study period to ensure effectiveness. Results: Our protocol resulted in zero transmissions to our health-care providers during the duration of the initial study. We were involved in greater than 150 sinonasal, skull base, open airway, and endoscopy procedures during this study. At the conclusion of the initial 5 weeks, we had no health-care providers test positive for SARS-CoV-2. Conclusion: According to our proposed protocol, we were able to provide care for all patients in clinic, hospital, emergent, intensive, and surgical settings with no transmission of SARS-CoV-2 by symptomatology and post evaluation testing.

Coronavirus Disease-19 and Rhinology/Facial Plastics

“… 3 , 16 In accordance with CDC guidelines, procedure rooms without negative pressure and continual HEPA filtration and air turnover should remain vacant following any AGP before cleaning, with timing based on a room’s ability for air handling and duration of time spent in room. 29 , 30 …”

“…Current guidelines recommend perioperative COVID-19 testing to be performed within 24 to 48 hours before elective high-risk aerosol generating surgeries. 16 , 30 …”

“…Although there are limited data in regard to specific efficacy against COVID-19 infections, PVP-I solutions of various dilute concentrations have been reported as safe and effective in decreasing viral and bacterial colonization of other species. 30 Although studies have shown that concentrations of 2.5% and higher are associated with ciliotoxic effects on ciliated human respiratory epithelial cells, safe use has been used at concentrations of 1.25% or less. 31 , 32 In contrast with the nasal mucosa, the oral mucosa, which lacks cilia, has been shown to tolerate concentrations to 5% PVP-I rinses applied intraorally for a duration of up to 6 months.…”

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic

“…In another cadaveric study, the authors performed simulated sinus surgery in fluorescein coated nasal/sinus mucosa and found limited droplet spread using powered instrumentation including a drill if a concurrent suction was used [84]. A prospective cohort study by Taha et al assessed the efficacy of a specific institution protocol in preventing transmission of COVID-19 to HCPs during otolaryngology care in a high prevalence setting [85]. All health care providers were required to wear p100 filter respirators, as well as eye protection, surgical gowns and gloves.…”

How Can We Reduce the Use of Nasal Endoscopy in the Outpatient Setting During COVID-19?

“…We read with interest the article by Taha et al 1 and congratulate the authors on providing a protocol to help control of COVID-19 transmission whilst performing rhinologic procedures. The COVID-19 outbreak has led to a radical reassessment of Ear, Nose and Throat (ENT) practice.…”