Topical preparations to reduce SARS‐CoV‐2 aerosolization in head and neck mucosal surgery

Abstract

Aim The COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. Methods A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. Results Povidone‐iodine (PVP‐I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS‐CoV‐1 and MERS‐CoV. Conclusions While specific evidence regarding SARS‐CoV‐2 is lacking, PVP‐I‐based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS‐CoV‐2 aerosolization during upper airway mucosal surgery.

Efficacy of Povidone-Iodine Nasal and Oral Antiseptic Preparations Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2)

“…Finally, nasal and oral decontamination with PVP-I is recommended to reduce the amount of virus particle aerosolization before it reaches barriers, surfaces, and fomites. [8][9][10]21 The challenge in nasal antisepsis is to find effective topical preparations which are safe to administer. Ethanol, for example, is known to be an effective virucidal agent but cannot be safely used in the nose.…”

Benefits and Safety of Nasal Saline Irrigations in a Pandemic—Washing COVID-19 Away

“…They identified 3 different studies of prior coronavirus epidemics in which topical application of povidone-iodine resulted in significant viral titer reduction. 5 Furthermore, a prospective trial of 0.08% diluted povidoneiodine rinses in 29 patients demonstrated safety and tolerance by patients. 6 There is concern regarding ciliotoxicity of iodine-based rinses; however, in diluted form these effects may be negligible.…”

“…Betadine and other iodine derivatives have also been proposed to reduce viral load in the nasal cavity. In a recent review by Parhar et al, 5 the role in povidoneiodine, a common surgical preparation, was evaluated. While they did not find many clinical trials, there was significant evidence of povidone-iodine resulting in substantial coronavirus reduction in in vitro studies.…”

Operative team checklist for aerosol generating procedures to minimise exposure of healthcare workers to SARS-CoV-2

“…Systemic steroids to reduce airway inflammation may need to be clarified depending on the patient's pathology and the latest evidence based recommendations for a known COVID-19 positive patient. The role of preparing the nasal and oral cavity with a 0.5% solution of povidone iodine on pledgets for its virocidal properties towards SARS-CoV-2 is unknown at this point in time [24][25][26][27] but is Talking through the process from start to finish can be helpful for the whole team to hear. In the rare event of an arrest situation, the anaesthetic team are expected to manage within the room without activation of the general emergency call button until other staff with appropriate PPE or PAPR arrive (concept of "Protected Code Blue" [11]).…”