Plettenberg C, Geipel K, Stenin I, Klenzner T, Wagenmann M, Schipper J, Scheckenbach K
Hals-Nasen-Ohrenklinik, Zentrum für Operative Medizin II, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
HNO. 2021 Aug;69(8):650-657. doi: 10.1007/s00106-021-01050-z. Epub 2021 Apr 14.
The COVID(coronavirus disease)-19 pandemic is characterized by high infectivity, droplet transmission, and high viral load in the upper respiratory tract. Severe disease courses are associated with interstitial pneumonia and ventilated patients, in whom tracheotomy (TT)-a droplet- and aerosol-producing medical intervention-is regularly necessary. TT as a potential infection risk for medical staff is scarcely found in the literature. Therefore, the aim of this study was to quantify droplet exposure of the surgical team during TT, to better define the requirements for personal protective equipment (PPE).
Surgical TT was performed in four non-infectious patients, during which the surgeon and his assistant both wore a surgical nasal mask with a transparent visor. After the procedure, the type, distribution, and number of droplets on the visor were determined macroscopically and microscopically.
An average of 29 droplets were found on the middle third of the visor, 4 on the right third, and 13 on the left third, with an average droplet size of 571 µm (± 381 µm). The smallest droplets were 55 µm, the largest 1431 µm. An increase in the number of droplets was found with increased ventilation during the procedure. Blood droplets were more common than secretion droplets.
Contamination of the visor with droplets was demonstrated. Especially in the case of TT in highly infectious patients, e.g., COVID-19 patients, the use of hooded headgear in combination with breathing apparatus with air purification and power supply is recommended to ensure best protection from infection for the surgeon and the surgical assistant.
新型冠状病毒肺炎（COVID-19）大流行的特点是传染性强、飞沫传播以及上呼吸道病毒载量高。严重病程与间质性肺炎和需要机械通气的患者相关，对于这些患者，气管切开术（TT）——一种会产生飞沫和气溶胶的医疗干预措施——通常是必要的。气管切开术作为医护人员潜在的感染风险在文献中鲜有提及。因此，本研究的目的是量化气管切开术期间手术团队的飞沫暴露情况，以更好地确定个人防护装备（PPE）的要求。
对4例非感染性患者进行外科气管切开术，术中外科医生及其助手均佩戴带有透明面罩的外科鼻罩。手术后，通过宏观和微观方法确定面罩上飞沫的类型、分布和数量。
在面罩中间三分之一处平均发现29个飞沫，右侧三分之一处发现4个，左侧三分之一处发现13个，飞沫平均大小为571 µm（± 381 µm）。最小的飞沫为55 µm，最大的为1431 µm。术中通气增加时，飞沫数量增多。血飞沫比分泌液飞沫更常见。
证实了面罩被飞沫污染。特别是对于高传染性患者，如COVID-19患者进行气管切开术时，建议使用带帽头盔并结合带有空气净化和电源的呼吸设备，以确保为外科医生和手术助手提供最佳的感染防护。
