Abstract
ObjectiveIn the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies.Study DesignProspective quantification of airborne aerosol generation during surgical and clinical simulation.SettingCadaver laboratory and clinical examination room.Subjects and MethodsAirborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation.ResultsHand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P < .001). In clinical simulations, nasal endoscopy (P < .05), speech (P < .01), and sneezing (P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread.ConclusionTransnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.
Highlights
Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 mm under surgical conditions
Airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing
The COVID-19 pandemic has catalyzed an unparalleled disruption in the provision of health care around the world
Summary
Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. The clinical simulation was reviewed by the Partner’s Human Research Committee director and performed under the Quality Improvement Initiative at Massachusetts Eye and Ear; as such, it was not required to be formally supervised by the Institutional Review Board per its policies. The clinical examination room (111 sq ft) and the surgical laboratory (726 sq ft) were equipped with air exchangers operating at a rate of 6 total air changes per hour. Aerosol sampling was performed with an optical particle sizer (OPS 3330; TSI Inc), which measures particle number, concentration, and size distribution with single particle– counting technology up to a size of 10 mm. Total particle counts by size over a period of timed data were collected
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