References
[1] Keogh IJ, Hone SW, Colreavey M, Walsh M. Blood splash and tonsillectomy: an underestimated hazard to the otolaryngologist. J Laryngol Otol. 2001 Jun;115(6):455-6.
[2] Hanna BC, Thompson P, Smyth C, Gallagher G. Blood splash from different diathermy instruments during tonsillectomy. J Laryngol Otol. 2006; 120(11): 927 – 31.
[3] Lakhani R, Loh Y, Zhang TT, Kothari P. A prospective study of blood splatter in ENT. Eur Arch Otorhinolaryngol. 2015 Jul;272(7):1809-12.
[4] Kowalski LP, Sanabria A, Ridge JA, Ng WT, de Bree R, Rinaldo A, Takes RP, Mäkitie AA, Carvalho AL, Bradford CR, Paleri V, Hartl DM, Vander Poorten V, Nixon IJ, Piazza C, Lacy PD, Rodrigo JP, Guntinas-Lichius O, Mendenhall WM, D'Cruz A, Lee AWM, Ferlito A. COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck. 2020 Jun;42(6):1259-1267.
[5] Carr MM, Patel VA, Soo JC, Friend S, Lee EG. Effect of Electrocautery Settings on Particulate Concentrations in Surgical Plume during Tonsillectomy. Otolaryngol Head Neck Surg. 2020 Jun;162(6):867-872.
[6] Keogh IJ, Hone SW, Colreavey M, Walsh M. Blood splash and tonsillectomy: an underestimated hazard to the otolaryngologist. J Laryngol Otol. 2001 Jun;115(6):455-6.
[7] Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev. 2017 Aug 22;8(8):CD004619.
[8] Daskalakis D, Tsetsos N, Karagergou S, Goudakos J, Markou K, Karkos P. Intracapsular coblation tonsillectomy versus extracapsular coblation tonsillectomy: a systematic review and a meta-analysis. Eur Arch Otorhinolaryngol. 2020 Jul 4. doi: 10.1007/s00405-020-06178-2. Online ahead of print.
[9] O'Brien DC, Lee EG, Soo JC, Friend S, Callaham S, Carr MM. Surgical Team Exposure to Cautery Smoke and Its Mitigation during Tonsillectomy. Otolaryngol Head Neck Surg. 2020 Sep;163(3):508-516.
[10] Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020 May 15;5:CD011621.
Succinct key points:
1. The Covid-19 pandemic has highlighted tonsillectomy as an aerosol generating procedure (AGP).
2. This is the first study to assess for droplet splatter contamination around the surgical field and on the surgeon during Coblation tonsillectomy.
3. Droplets were detected in all four quadrants of the surgical fields with the greatest in the upper (nearest to surgeon) and lower quadrants.
4. Splatter droplets were most frequently occurring on the hands of the surgeon followed by the forearm, and less frequently on the visor, neck, and chest.
5. Although wearing a face visor does not prevent splatter on the surgical mask or around the eyes, it should be considered when undertaking tonsil surgery as well as a properly fitted goggle.
Legend to tables and figures
Figure 1. Experimental setup: (a) Head model with Boyle–Davis and Draffin rods in-situ. (b) Fluorescein-soaked strawberries used to mimic tonsils. (c) Fluorecein infused into saline irrigation bag and tubing connected to Coblation pump. (d) Close-up of simulated tonsil surgery using the Coblation Procise wand. Note the hole in the black sheet covering the model but providing access to the oropharynx.
Figure 2. a) Quadrants of surgical field b)Anatomical subsites of surgeon (Right and left hands, forearms and arms, chest, neck and face) including face shield
Figure 3. Frequency of detected droplet spread around the surgical field by individual (a and b) and average (c); 0 = white, 1-2 = yellow, 3-4 = orange and 5 = red.
Figure 4. Heatmap of anatomical areas of each surgeon (a and b) including face shield.