Surgeons, Be Careful With OR! –How To Avoid COVID-19 Transmission During Surgery

Surgeons, Be Careful With OR! –How To Avoid COVID-19 Transmission During Surgery

October 12, 2020

Since COVID-19 created a substantial backlog of cataract procedures for ophthalmologists, a countless number of elective surgeries had to be canceled worldwide. It is still not clear when we will get back to “usual practice”. There is still a lot to overcome on the way through getting back in “usual practice”. As surgeons begin to clear this inevitable waiting-list, it is indeed very important to understand and minimize all possible routes of infection during surgery.

PPE – Personal Protective Equipment for infection control measures plays a very important role in decreasing transmission rates during the clinic and hospital visits. Yes, having seen decreased transmission rates through PPE is a very good sign; But What About OR – Operating Room Conditions?

Since Ophthalmologists spend long periods in close proximity to a patient’s mucosal membranes during surgery, the risk for surgeons contracting COVID-19 is higher. The mucosal membrane is where the virus first and foremost is located in the human body. Covid-19 loves Mucosal Membrane! Remember – Even the Covid-19 testing is performed at the Mucosal Membrane!

All the movements in and around the operating room could also be problematic. Problematic in the sense that the unfolding process of the PPE like a surgical gown or drape has the potential of potentially infectious airborne particle transmission.

Even when appropriate PPE is used according to the standard medical procedures, possible air leakage from underneath the surgical drape seal around the patient’s eye is the dangerous part. Also, staff turnover is considered very risky in operating rooms. Surgical site infection rates drop in hospitals with lower turnover.

Due to drape or gown movement throughout the day, there is a high risk of viral transmission. With a very high case turnover rate, Ophthalmology surgeries are indeed a big concern.

Also, surgeons may work even longer hours in a bid to clear the strenuous, pandemic-induced backlogs of cataract surgeries. Health authorities may even increase the volume of surgeries conducted, for instance by allowing OR time during weekends. So, it’s essential to examine all possible infection risks in the OR and make every effort to mitigate them.

Condensation Appearance On The IOL

According to the observations in surgeries, when the IOL was placed 1 cm above the patient’s eye just before insertion, it was observed that condensation appeared in synchronicity with the patient’s breathing. This condensation is truly an indicator of air leakage from underneath the surgical drape seal around the patient’s eye.

The Danger of Leakage

Indeed this patient’s breath leakage has a great potential of infection risk of COVID-19 from patient to surgeon. Surgeons – How can we mitigate the risk of virus spreading?

Taping Face Masks of Patients

Surgeons and OR staff must protect themselves from any factors that could potentially increase their risk of infection. Therefore it is strongly recommended that any surgeon who performs IOL insertion surgery, should tape facemasks onto the patient’s midface before all surgeries as a solution to reduce air leakage.

Besides using the PPE, taping face masks of patients along the top brim onto the midface before surgery could indeed prevent infection. In light of this taping method, a significant reduction in condensation appearing on the IOL can be seen. This simple adjustment to a patient’s face mask can prevent the spread of respiratory droplets.

Also, applying a complete seal when draping around the eye is very important. In terms of ensuring a complete seal, these following steps are recommended;

  • Drying the skin of the patient around the eye thoroughly from any antiseptic preparation solution
  • Pressing firmly down on the patient’s eye for a longer duration when applying the adhesive
  • Holding one hand down on the drape adhesive attached to the eye when using the other hand to toss the remaining portion of the drape toward the waist of the patient

In light of the fact that a complete seal with adhesive tape around the surgical field along with a taped facemask can prevent the spread of respiratory droplets, it is very important to ensure the seal’s integrity. In every sense of the word, it is vital to consider implementing these very simple steps during any IOL insertion surgery.