2.3 Adjunctive techniques
Other groups have considered more novel applications to mitigate risk.
Three studies tested the fitment of a specific mask on the
patient.16,18,28 All such work was performed in
simulated settings and considered droplet spread in terms of splatter
evaluated through fluorescent tracing with fluorescein. Viera-Artiles et
al. (2020)28 and Helman et al.
(2020)18 used 3-D printed mask designs and evaluated
droplet dispersal following endonasal high-speed drill use. Whilst both
studies noted a reduction in droplet detection, neither prevented
droplet aerosolisation completely. Jones et al.
(2020)16 added suction beneath their patient mask to
create a negative pressure environment finding that droplet spread was
eliminated during cadaveric sinus surgery simulations using both the
microdebrider and high-speed drill. Though encouraging, this work does
not consider aerosolisation of smaller particles.
Five very similar feasibility studies report on their experience of
specific patient draping.29-33 The majority employ a
polythene sheet, under which the surgeon
operates.29-32 Of these, only Arefin et al.
(2021)29 published outcomes, reporting no COVID-19
infections amongst twelve theatre team members over a five-month 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)16above, attached suction to create a negative pressure environment.
Ioannidis et al. (2020)34 considered the
aerosolisation of small particles, simulated with a smoke generator in a
plastic manikin. An OPC (Fluke 985; Fluke Co., USA) was used to measure
particles 0.3-0.5μm which were still detected outside of their drape
system, albeit at reduced levels. Similarly, David et al.
(2020)35 found that fluorescein droplets continued to
be noted outside of their draping in two of four patients evaluated.