Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks

Howard, Rex A.; Lathrop, George; Powell, Nathaniel

doi:10.1016/j.ajic.2019.08.009

Cited by 31 publications

(32 citation statements)

References 3 publications

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“…It is important to understand that aerosols can be generated either by surgery or by the respiration of the patient within the theatre [37,38]. ENT, Neurosurgery, and Opthalmology surgeons are at risk from both types of aerosols while orthopedic surgeons are exposed to high levels of surgical aerosol but a lower risk of respiratory aerosol.…”

Section: Intraoperative Protocolmentioning

confidence: 99%

COVID-19 in the operating room: a review of evolving safety protocols

Prakash¹,

Dhar

Mushtaq

2020

Patient Saf Surg

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Background: The COVID-19 pandemic has already infected more than 3 million people across the world. As the healthworkers man the frontlines, the best practices model is continuously evolving as literature concerning the Coronavirus develops. Methods: A systematic review of the available literature was performed using the keyword terms "COVID-19", "Coronavirus", "surgeon", "health-care workers", "protection" and "Orthopaedic Surgery". All peer-reviewed articles we could find were considered. Randomized controlled trials (RCTs), prospective trials and retrospective studies, as well as reviews and case reports, were included in this systematic review. Results: Even though surgical specialties including orthopedics are on the relative sidelines of the management of this pandemic but best practices models are inevitably developed for surgical specialties. The algorithm of postpone, delay, and operate only when life-threatening conditions exist is going to be useful up to a point. Conclusion: The surgical staff needs to keep abreast of the latest literature concerning safety measures to be taken during surgical procedures. Review articles can go some distance in helping in this educational process. This knowledge must evolve as new information comes to light.

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Section: Intraoperative Protocolmentioning

confidence: 99%

COVID-19 in the operating room: a review of evolving safety protocols

Prakash¹,

Dhar

Mushtaq

2020

Patient Saf Surg

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“…Although this study was modeled after prior studies from the CDC with smaller samples, a larger data set would improve the strength of conclusions. 18 Given the similarity in particle data between all 5 masking groups, a much larger sample focusing only on aerosol generating activities should be performed to potentially detect aerosol generation differences. In this study, only one type of EHMR was tested with a forwardfacing exhalation valve.…”

Section: Particle Resultsmentioning

confidence: 99%

“…The methodology of this experimental study was adapted from the CDC study on PAPR/CAPRs sterile eld contamination. 18 Experimental design, operating room setup, participant characteristics, testing battery, data collection, and statistical methods are outlined below.…”

Section: Methodsmentioning

confidence: 99%

Sterile Field Contamination by Elastomeric Respirators Versus Surgical Masks and N95s

Howard

Thorwarth

Karam

et al. 2020

Preprint

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Background: Elastomeric respirators are reusable and reliable protection from infectious aerosol particles such as SARS-CoV-2. There is a lack of safety data for use in sterile fields limiting application to operating room settings where high-risk aerosol generating procedures are performed. We hypothesized an equivalent reduction in sterile field contamination would be achieved using an elastomeric respirator covered by a surgical mask as compared to a standard surgical mask or N95.Methods: Randomized controlled crossover experiment with repeat measurement comparing microbial and aerosol contamination of operating room surfaces for elastomeric respirators, elastomeric respirators covered by a surgical mask, N95, surgical mask, and no mask. 80 experiments were performed by participants with randomized order and balanced crossover to all masking groups (n=16 per masking group). Participants executed droplet and aerosol generating procedures while wearing: (Group 1) elastomeric respirator with mask, (Group 2) elastomeric respirator only, (Group 3) N95, and (Group 4) surgical mask. Positive control was established with the participant unmasked (Group 5). Contamination was measured by microbial growth on settling plates and optical particle counters (0.2+ and 2 um+ particles).Results: There was a reduction in microbial contamination at the sterile field (p<0.001) for all masks (Groups 1-4) compared to unmasked (Group 5). The mean colony forming units (CFU) at the sterile field was 0 CFUs for elastomeric respirator (+/- mask), N95, and surgical mask versus unmasked growing 1.875 CFUs. Compared to the unmasked control, the elastomeric respirator (+/- mask), N95, and surgical masks all resulted in a -0.75 difference in contamination (95% CI -0.91 to -0.48, p < 0.001). No significant difference in contamination between the elastomeric respirator (+/- mask) and a surgical mask was detected. No significant difference in particle counts (0.2 µm+ and 2.0 µm+) between the elastomeric respirator (+/- mask) and a standard surgical mask.Conclusion and Relevance: Elastomeric respirators with or without mitigation are as effective as a surgical mask and N95 for reducing contamination at the sterile field in an operating room. Consideration should be given to expanding the use of elastomeric respirators to operating rooms during high-risk aerosol generating procedures.

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“…25 In another study, surgical masks, and PAPRs reduced contamination of the sterile field by 98.48% and 100% respectively compared to no face covering. 26 Table-2 summarizes the currently available types of face masks, face shields, face visors, and goggles as well as advantages and disadvantages of use.…”

Section: Ppe In Usementioning

confidence: 99%

The Urologist, Personal Protective Equipment (PPE) and COVID-19

Mukherjee

Bonatsos

Raza

2020

Journal of Endoluminal Endourology

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Background and ObjectiveTo review the literature from a urologist’s perspective regarding the use of Personal Protective Equipment (PPE), associated challenges, and other potential measures that can be taken to reduce the risk of nosocomial COVID-19 transmission. Material and MethodsA literature review using PubMed, Cochrane Review, and Google Scholar database search was performed using the keyword terms “COVID-19”, “Coronavirus”, “Personal Protective Equipment” (PPE), “healthcare workers” (HCW), “protection”, “masks”, and “urology”. Non-English articles were excluded. We present a summary of key guidance provided by regulatory bodies as well as some of the key articles published to date relating to PPE. DiscussionSARS-CoV-2 virus is found mainly in the respiratory system but is also in blood, feces, semen, and urine. Both standard infection control precautions (SICPs) and transmission-based precautions (TBPs) are nec-essary to reduce nosocomial transmission of COVID-19 infection. PPE includes gowns, gloves, masks or respirators, goggles, and face shields; however, wearing PPE is only part of many precautionary measures that are necessary to prevent viral transmission. When used appropriately PPE not only protects HCWs from patients but also protects patients from HCWs who may be asymptomatic carriers of COVID-19 infection. Attention should also be paid to fit testing and fit checking, donning and doffing, and ever-evolving guide-lines on PPE. Wearing PPE for a long time is also technically challenging and may adversely affect surgical outcomes. Shortages of PPE in the supply chain during the peak of the pandemic as well as concerns about substandard PPE should be considered for a possible second wave of COVID-19. Other key measures to minimize nosocomial SARS-CoV-2 virus transmission are a symptom and temperature screening of patients and staff; controlling the flow of patients, staff, and relatives in hospitals; self-isolation by patients before elective surgery; a robust testing protocol for both patients and staff; patient and staff cohorting; physical distancing; good hand hygiene; respiratory etiquette including face coverings for patients, staff and visitors; proper disposal of waste and enhanced cleaning; thorough cleaning and sterilization of surgical equipment performed post-operatively; choosing suitable anesthetic methods to minimize aerosolization of the virus; and if possible ensuring a negative-pressure theatre environment while dealing with COVID-19 positive patients. As scientific and regulatory bodies continue to issue updated guidance as more data is collected and a better knowledge base is developed regarding COVID-19 employers and staff need to keep up to date with guidance also. ConclusionCOVID-19 will be around for the foreseeable future and infection rates may fluctuate as restrictions are eased. HCWs including urologists should take appropriate PPE measures not only in theatres, clinics, and endoscopy suits but also when performing simple tasks such as urine dipsticks, catheter, nephrostomy management, digital rectal examination (DRE), prostate biopsies, etc. as SARS-CoV-2 can be detected in feces, urine, and semen. Both employers and HCWs should adhere strictly to current guidelines and work together to minimize nosocomial transmission of COVID-19 infection.

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Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks

Cited by 31 publications

References 3 publications

COVID-19 in the operating room: a review of evolving safety protocols

COVID-19 in the operating room: a review of evolving safety protocols

Sterile Field Contamination by Elastomeric Respirators Versus Surgical Masks and N95s

The Urologist, Personal Protective Equipment (PPE) and COVID-19

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