SNOT FORCE studies exposure risk to providers in nasal surgery

Physicians must first protect themselves with the right gear or personal protective equipment (PPE). A standard surgical mask, gown, gloves, and face-shield can protect against virus particles in droplets. But smaller particles, called aerosols, require more heavy-duty airborne protection. So, is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmitted by droplets or aerosols? 239 scientists certainly felt strongly enough that it’s airborne, writing a letter to the World Health Organization (WHO).

Our research group set out to investigate the droplet and aerosol risks from routine procedures performed within the nose.            

The good news first.
We found that there really wasn’t much droplets or splatter unless you used the drill outside the nose, suggesting that it functions as a barrier that protects us during surgery. The icing on the cake is that using a suction device in the nose completely eliminated all droplet contamination. 

The bad news? 
Our second study confirmed we were generating aerosols. Drilling bone in the nose produced the most aerosols. Most of these particles were less than 1 micron! Thankfully, all three suction devices we tested were effective in reducing aerosols, and the surgical smoke evacuation system placed right outside the nose seems to be the best at it.

Why is this important? 
The WHO now says that airborne transmission of SARS-CoV-2 can occur during aerosol-generating procedures (AGP). We believe this is why it is important to establish which procedures are AGPs. Because, after all, we can only take care of our patients if we stay healthy. 

Dhruv Sharma, MD

I am a resident physician at the Indiana University School of Medicine Department of Otolaryngology - Head and Neck Surgery

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