Personal protective equipment against COVID-19: Vital for surgeons, harmful for patients?

• Published in: The American journal of surgery Vol. 221; no. 4; pp. 772 - 774
• Main Authors: Frountzas, Maximos, Nikolaou, Christina, Schizas, Dimitrios, Toutouzas, Konstantinos G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2021; Elsevier Limited
• Subjects: Aerosols; Coronaviruses; COVID-19; COVID-19 - prevention & control; Dermatitis; Disease transmission; Eye protection; Gastrointestinal tract; Gloves; Goggles; Headaches; Humans; Infection Control - methods; Intensive care; Intubation; Laparoscopy; Masks; Mechanical ventilation; Medical personnel; Medical supplies; My Thoughts / My Surgical Practice; Patient Safety; Patients; Personal protective equipment; Personal Protective Equipment - adverse effects; Protective equipment; Respirators; Resuscitation; Risk; RNA viruses; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Skin diseases; Surgeons; Surgery; Ventilation; Ventilators; Viral diseases; Viruses
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.09.014

Tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation and manual ventilation before intubation were considered as high-risk AGPs. [...]due to the increased risk for COVID-19 transmission during pneumoperitoneum creation for laparoscopy, a dilemma between laparoscopy and laparotomy had to be answered even for operations that laparoscopy is strongly indicated.5 Previous experience with SARS showed a potential viral load of these procedures and increased risks for viral transmission. [...]most of RNA-viruses had been identified inside the human gastrointestinal (GI) tract in the past.6 Because of the possible contact with increased COVID-19 load during open and laparoscopic GI surgery, such procedures were classified as high-risk AGPs, despite the decreased aerosol generation. [...]the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), followed by most GI surgical communities all over the world, suggested the following PPE during GI surgery of a confirmed or highly suspected COVID-19 patient7: ‐N95 or filtering facepiece (FFP) 2 respirator masks or controlled air purifying respirators (CAPRs) for mouth and nose protection. ‐Goggles or face shields for eye protection. ‐Surgical gowns, caps and shoe covers for skin and clothing protection. ‐Gloves for hand protection. [...]surgeons and OR staff are expected to be more exposed to PPE during surgery.