Aerosolization risk during endoscopic transnasal surgery: a prospective qualitative and quantitative microscopic analysis of particles spreading in the operating room

2021 ◽  
pp. 1-9
Author(s):  
Federico Russo ◽  
Marco Valentini ◽  
Daniele Sabatino ◽  
Michele Cerati ◽  
Carla Facco ◽  
...  
Keyword(s):  
Operating Room ◽  
Surgical Procedures ◽  
Healthcare Workers ◽  
Microscopic Analysis ◽  
Significant Degree ◽  
Liquid Droplets ◽  
Operating Theater ◽  
Endoscopic Endonasal ◽  
Microscopic Evaluation ◽  
Transnasal Surgery

OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic represents the greatest public health emergency of this century. The primary mode of viral transmission is droplet transmission through direct contact with large droplets generated during breathing, talking, coughing, and sneezing. However, the virus can also demonstrate airborne transmission through smaller droplets (< 5 μm in diameter) generated during various medical procedures, collectively termed aerosol-generating procedures. The aim of this study was to analyze droplet contamination of healthcare workers and splatter patterns in the operating theater that resulted from endoscopic transnasal procedures in noninfected patients. METHODS A prospective nonrandomized microscopic evaluation of contaminants generated during 10 endoscopic transnasal procedures performed from May 14 to June 11, 2020, in the same operating theater was carried out. A dilution of monosodium fluorescein, repeatedly instilled through nasal irrigation, was used as a marker of contaminants generated during surgical procedures. Contaminants were collected on detectors worn by healthcare workers and placed in standard points in the operating theater. Analysis of number, dimensions, and characteristics of contaminants was carried out with fluorescence microscopy. RESULTS A total of 70 samples collected from 10 surgical procedures were analyzed. Liquid droplets and solid-tissue fragments were identified as contaminants on all detectors analyzed. All healthcare workers appeared to have been exposed to a significant number of contaminants. A significant degree of contamination was observed in every site of the operating room. The mean (range) diameter of liquid droplets was 4.1 (1.0–26.6) μm and that of solid fragments was 23.6 (3.5–263.3) μm. CONCLUSIONS Endoscopic endonasal surgery is associated with the generation of large amounts of contaminants, some of which measure less than 5 μm. All healthcare workers in the surgical room are exposed to a significant and similar risk of contamination; therefore, adequate personal protective equipment should be employed when performing endoscopic endonasal surgical procedures.

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

Innovative Draping Method to Mitigate Aerosolization During Coronavirus Pandemic

2020 ◽  
Vol 3 (2) ◽  
pp. 73-76
Author(s):  
Kripa Dongol ◽  
Yogesh Neupane ◽  
Dipesh Shakya
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Operating Room ◽  
Healthcare Workers ◽  
Operative Procedure ◽  
High Viral Load ◽  
Upper Airways ◽  
Self Confidence ◽  
Additional Form

Otolaryngologists are at high risk of acquiring coronavirus because most of the procedures are aerosol generating and we have to deal with upper airways which contain high viral load. The objective of this study is to elaborate the draping technique which diminishes aerosol in the operating room. Use of a framework and a drape with customized hand insertion ports help to contain the aerosol generated during the operative procedure. The draping technique acts as an additional form of protection from aerosol along with an increase in self-confidence to the healthcare workers during this pandemic.

Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Operating Room ◽  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Secondary Analysis ◽  
The United States ◽  
Tube Placement ◽  
The Mean ◽  
Room Time ◽  
Ambulatory Procedures

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Microscopic Evaluation of Salvia stepposa Des.- Schost above - ground part widespread in Kazakhstan

2021 ◽  
pp. 4773-4776
Author(s):  
Levaya Ya. K. ◽  
Ishmuratova M. Yu. ◽  
Atazhanova G. A. ◽  
Zilfikarov I. N. ◽  
Loseva I. V.
Keyword(s):  
Raw Materials ◽  
Microscopic Analysis ◽  
Raw Material ◽  
Medical Systems ◽  
Anatomical Structures ◽  
Anatomical Features ◽  
Mesophyll Structure ◽  
Microscopic Evaluation ◽  
Diagnostic Signs ◽  
Ground Part

Microscopic analysis of medicinal plants and raw materials is one of the stages of quality control which makes it possible to determine the authenticity of an object. This article presents the results of microscopic analysis of leaves, corolla, leafstalks and stalk of Salvia stepposa (steppe sage). This species is a relative to Salvia officinalis officinal used in traditional medical systems as an anti-inflammatory agent. The purpose of this study is to determine the features of the anatomical structures of the above-ground part of steppe sage and to reveal diagnostic signs at the microscopic level. Preliminary pharmacognostic investigation of vegetative raw material is done and diagnostic signs are identified. The detail microscopy revealed the presence of 3 types of trichomes on leaves’ epidermis: 1) simple unicellular; 2) simple multicellular; 3) glandular; their localization and shape are determined. Type of mesophyll, structure of trichomes; form and location of epidermal cells, the presence of rare simple trichomes along the edge are discovered. As a result of the research the anatomical features of the raw material were established, which make it possible to identify the above-ground part of Salvia stepposa and can be used for the development of regulatory documentation.

Procedures in the Adult and Neonatal Intensive Care Units

2018 ◽  
Author(s):  
Matthew Read ◽  
Christopher V. Maani
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
Intensive Care Units ◽  
Surgical Procedures ◽  
Neonatal Intensive Care ◽  
Critical Care Medicine ◽  
Neonatal Intensive Care Units ◽  
Anesthesia Practice ◽  
Urgent Procedure

Bedside procedures in the ICU are an integral component of critical care medicine. Anesthesiologists who are assigned to the ICU must adapt principles of safe and effective anesthesia practice to this novel outside-of-the-operating-room environment. There are several reasons for surgical procedures to sometimes be performed at the bedside in the ICU, such as the avoidance of transporting unstable patients from the ICU to the OR, or the lack of adequate time to mobilize resources to perform an urgent procedure in the OR. Readiness of the entire ICU team is essential to avoid compromising care due to production pressure or lack of standards routine to the OR environment. This chapter discusses the types of procedures performed in the ICU and reviews the requirements of performing them successfully.

Surveillance for Postoperative Infections in Outpatient Gynecologic Surgery

1986 ◽  
Vol 7 (2) ◽  
pp. 54-58 ◽  
Author(s):  
James M. Garvey ◽  
Carol Buffenmyer ◽  
Russel Rule Rycheck ◽  
Robert Yee ◽  
Joanne McVay ◽  
...  
Keyword(s):  
Operating Room ◽  
Surgical Procedures ◽  
Surveillance System ◽  
Gynecologic Surgery ◽  
Computer Assisted ◽  
Postoperative Infections ◽  
Infection Surveillance ◽  
Life Threatening ◽  
The Difference ◽  
Clean Contaminated

AbstractPostoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the “clean-contaminated” wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.

The Endoscopic Diving Technique in Pituitary and Cranial Base Surgery

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. E400-E401 ◽  
Author(s):  
Davide Locatelli ◽  
Frank Rikki Canevari ◽  
Ilaria Acchiardi ◽  
Paolo Castelnuovo
Keyword(s):  
Cavernous Sinus ◽  
Surgical Procedures ◽  
Endoscopic Surgical Procedures ◽  
Endoscopic Endonasal ◽  
Tumor Residue ◽  
Sinus Cavity ◽  
Cranial Base Surgery ◽  
Cranial Fossa ◽  
Surgical Field ◽  
Base Of The Skull

Abstract OBJECTIVE We used the diving technique to go beyond mere visualization of the surgical field and used it as an important step in removing the lesion itself, improving the optical field, and optimizing visualization with a dynamic fluid film lens. Likewise, having extended endoscopic endonasal surgery to the entire base of the skull and in particular to the sinus cavity, “diving surgery” has proven to be effective in visualizing and dissecting more extended tumors. METHODS We performed diving surgery in more than 350 surgical procedures to remove lesions in the sellar, sinus cavity, and clival regions. Intrasellar hydroscopy was performed in all cases to check that the lesion was removed completely and to gently dissect any intracavitary residual tumoral tissue. Diving surgery can be performed in the sellar cavity, in the cavernous sinus, and at the level of the posterior cranial fossa in the cavity obtained after clivectomy. RESULTS The hydrodissection and continuous flushing of the sellar cavity, together with better control of bleeding, allow the surgeon to perform piecemeal removal of the lesion with direct control of the cleavage plane and tumor residue and avoid blind curettage near the pituitary gland. This technique is particularly useful in identifying small infiltrations of the cavernous sinus and in checking the integrity of the pituitary stalk when instruments are introduced into the sella. CONCLUSION Diving surgery is a useful step in dealing with minor complications that can occur during endonasal endoscopic surgical procedures.

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