Aerosol Transmission of Infectious Agents During Mastoid Drilling

A Cost-effective Solution to Limit Aerosol Transmission of Infectious Agents During Mastoid Drilling:



To the Editor We were interested by the recent article by Carron, et al “A Simple Technique for Droplet Control During Mastoid Surgery” because we have also been considering the challenges of performing mastoidectomy in the coronavirus disease 2019 era. Mastoidectomy is an aerosol-generating procedure (AGP) owing to the use of drills and presence of potentially virus-containing respiratory mucosa lining the mastoid air cells. The recommended personal protective equipment for AGPs is a FFP3 mask and a face visor to prevent aerosolized particles coming into contact with mucosal surfaces of the face, including the nose, mouth, and eyes. As the authors point out “using a microscope with a face shield is virtually impossible.” Clamp and Broomfield quantified this, demonstrating that face shields reduced the surgical view to a median of 4%. Although the use of plastic drapes are 1 alternative to a face shield, they are somewhat problematic. Instruments have to be passed beneath the drapes by the scrub nurse, which is slow and cumbersome. The seal is not airtight, and lifting drapes to change instruments releases viral particles into the theater environment. Third, there is the contamination risk to the surgical team and environment when removing the drapes afterwards.