Tags

Type your tag names separated by a space and hit enter

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon.
Knee Surg Sports Traumatol Arthrosc. 2020 Jun; 28(6):1690-1698.KS

Abstract

PURPOSE

With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons.

METHODS

A systematic review of the available literature was performed using the keyword terms "COVID-19", "Coronavirus", "surgeon", "health-care workers", "protection", "masks", "gloves", "gowns", "helmets", and "aerosol" in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations.

RESULTS

World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination.

CONCLUSION

Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard.

LEVEL OF EVIDENCE

IV.

Authors+Show Affiliations

Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), 4101, Bruderholz, Switzerland. Michael.Hirschmann@unibas.ch. University of Basel, 4051, Basel, Switzerland. Michael.Hirschmann@unibas.ch.UCL Stanmore Campus, Royal National Orthopaedic Hospital Brockley Hill, Stanmore, UK.UCL Stanmore Campus, Royal National Orthopaedic Hospital Brockley Hill, Stanmore, UK.Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg. Luxembourg Institute of Health, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32342138

Citation

Hirschmann, Michael T., et al. "COVID-19 Coronavirus: Recommended Personal Protective Equipment for the Orthopaedic and Trauma Surgeon." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 28, no. 6, 2020, pp. 1690-1698.
Hirschmann MT, Hart A, Henckel J, et al. COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1690-1698.
Hirschmann, M. T., Hart, A., Henckel, J., Sadoghi, P., Seil, R., & Mouton, C. (2020). COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 28(6), 1690-1698. https://doi.org/10.1007/s00167-020-06022-4
Hirschmann MT, et al. COVID-19 Coronavirus: Recommended Personal Protective Equipment for the Orthopaedic and Trauma Surgeon. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1690-1698. PubMed PMID: 32342138.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. AU - Hirschmann,Michael T, AU - Hart,Alister, AU - Henckel,Johann, AU - Sadoghi,Patrick, AU - Seil,Romain, AU - Mouton,Caroline, Y1 - 2020/04/27/ PY - 2020/04/12/received PY - 2020/04/21/accepted PY - 2020/4/29/pubmed PY - 2020/6/2/medline PY - 2020/4/29/entrez KW - Aerosols KW - COVID-19 KW - Corona KW - Helmet KW - Masks KW - Personal protective equipment KW - Protection KW - Respirator masks KW - Suits KW - Surgeon SP - 1690 EP - 1698 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 28 IS - 6 N2 - PURPOSE: With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. METHODS: A systematic review of the available literature was performed using the keyword terms "COVID-19", "Coronavirus", "surgeon", "health-care workers", "protection", "masks", "gloves", "gowns", "helmets", and "aerosol" in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations. RESULTS: World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. CONCLUSION: Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. LEVEL OF EVIDENCE: IV. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/32342138/COVID_19_coronavirus:_recommended_personal_protective_equipment_for_the_orthopaedic_and_trauma_surgeon_ L2 - https://dx.doi.org/10.1007/s00167-020-06022-4 DB - PRIME DP - Unbound Medicine ER -