SLS is committed to providing our members with information to help you navigate these challenging times. We extend our gratitude to all the physicians and healthcare providers who are working tirelessly to save the lives of those infected with COVID-19.
– DOWNLOAD PDF from the FDA: Enforcement Policy for Face Masks & Respirators During the COVID-19 Public Health Emergency
– DOWNLOAD PDF from the FDA: Surgical Mask and Gown Conservation Strategies – Letter to Health Care Providers
– DOWNLOAD PDF from the CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
– DOWNLOAD PDF from the FDA: Enforcement Policy for Face Masks & Respirators During the COVID-19 Public Health Emergency
– DOWNLOAD PDF from the FDA: Surgical Mask and Gown Conservation Strategies – Letter to Health Care Providers
– DOWNLOAD PDF from Annals of Surgery: A Low Cost, Safe and Effective Method for Smoke Evacuation in Laparoscopic Surgery for Suspected Coronavirus Patients
– DOWNLOAD PDF from the CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
– DOWNLOAD PDF from the FDA: Enforcement Policy for Face Masks and Respirators During the COVID-19 Public Health Emergency
– DOWNLOAD PDF from the FDA: Surgical Mask and Gown Conservation Strategies – Letter to Health Care Providers
– VIEW Updated CDC COVID-19 Guidance
– DOWNLOAD PDF from Journal of the American College of Surgeons: Medically-Necessary, Time-Sensitive Procedures: A Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic
– DOWNLOAD PDF from Science about how the pandemic may continue into 2022
– DOWNLOAD PDF from the CDC on cleaning face masks
CLEARING THE AIR IN THE OPERATING ROOM DURING COVID-19 AND BEYOND
Potential transmission of the COVID-19 virus to surgical staff during aerosol-generating procedures, including laparoscopic surgery, is a growing concern as more operations on suspected or confirmed COVID-19 patients are necessitated and being performed. Although COVID-19 has not yet been documented in surgical smoke (tissue plume), surgeons must use precautions to reduce the risks to operating room (OR) staff.
There is little question that respiratory circuit and related procedures represent the greatest risk of generating COVID-19 laden aerosols, and universal precautions should be followed as a standard practice.
Concern has been raised regarding potential COVID-19 in vaporized tissue plumes and release of gas from laparoscopic or endoscopic procedures. This has included concern about blood-related aerosols. However, as the American Association of Blood Banks points out, COVID-19, unlike HIV and hepatitis viruses, is a respiratory virus and there is no evidence that the virus is present in blood.
That said, COVID-19 does involve the GI tract, and viral particles have been recovered from feces of infected patients. This likely means that intestinal contents can be contaminated and handling intestinal fluids and minimizing aerosolization of these fluids is prudent.
There is also ample evidence that surgical smoke (vaporized tissue plume) regardless of its source, including gases from laparoscopic and endoscopic procedures can be noxious and can present health hazards irrespective of the presence of COVID-19 or other agents. It therefore behooves all of us to avoid releasing laparoscopic gases and tissue plumes into the room and OR environment. We have listed a series of references and resources below that cover some of these topics as well as a partial list of companies that produce products to evacuate smoke during laparoscopic and other procedures.
The COVID-19 pandemic has brought heightened awareness regarding potential hazards in the OR environment. Safety should always be our primary concern, whenever we perform procedures, during pandemics and during more normal times.
REFERENCES/RESOURCES
– American Association of Blood Banks Statement on Coronavirus and Blood Donation. http://www.aabb.org/advocacy/regulatorygovernment/Pages/Statement-on-Coronavirus-and-Blood-Donation.aspx
– Zhang J, Wang S, Xue Y. Fecal specimen diagnosis 2019 novel coronavirus‐infected pneumonia. J Med Virol. 2020. https://doi.org/10.1002/jmv.25742
– Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382: 727‐ 733.
– Ding Y, He L, Zhang Q, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS‐CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol. 2004; 203(2): 622‐ 630.
– SAGES Recommendations Regarding Surgical Response to COVID-19 Crisis. https://www.sages.org/recommendations-surgical-response-covid-19/
– ANSI/AIHA Z88.6-2006, American National Standard Respiratory Protection – Respirator Use – Physical Qualifications for Personnel.
– ANSI/AIHA Z9.2-2006, American National Standard Fundamentals Governing the Design and Operation of Local Exhaust Ventilation Systems.
– ANSI/ASSE Z87.1-2003, American National Standard Occupational and Educational Personal Eye and Face Protection Devices
– CSA Z305.13-13, Plume Scavenging in surgical, diagnostic, therapeutic, and aesthetic settings, Canadian Standards Association.
– ANSI Z136.3-2018, American National Standard for Safe Use of Lasers in Health Care.
PARTIAL LISTING OF COMPANIES WITH LAPAROSCOPIC SMOKE EVACUATION PRODUCTS