Feasibility of cleft lip and palate repair in personal protective equipment (PPE)

Elective surgery during the evolving COVID-19 pandemic presents unprecedented logistical challenges to surgical teams. Cleft may be considered an aerosol generating procedure (AGP), which lead small-droplet transmission of virions. Strict adherence personal protective equipment (PPE) policy is used with hope preventing virus between patients and operating theatre staff. The World Health Organisation (WHO) guidance for infection prevention control health care when suspected recommends that healthcare workers performing AGPs should use a half-face particulate respirator at least as European Union (EU) standard Filtering Face Piece 2 (FFP2) or equivalent.1World Organisation. Infection novel coronavirus (nCoV) suspected. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125 [Accessibility verified 5 May 2020].Google Scholar Public England have published extensive on PPE British Association Plastic, Reconstructive Aesthetic Surgeons (BAPRAS) has provided interpretation this plastic surgeons.2British Plastic Surgeons. BAPRAS guideline - reducing risk surgeons. http://www.bapras.org.uk/docs/default-source/covid-19-docs/ppe-guidance-for-plastic-surgeons-bapras-branding.pdf?sfvrsn=2 7 Recently safety recommendations ear, nose throat (ENT) also provide useful surgeons who perform AGPs.3Givi B. Schiff B.A. Chinn S.B. et al.Safety evaluation head neck pandemic.JAMA Otolaryngol Head Neck Surg. 2020; Crossref PubMed Scopus (412) Google most common types respirators in are filtering facepiece (FFP) powered air purifying (PAPRs). A PAPR battery-powered, air-purifying uses pump force through filter cartridges into breathing zone wearer within loose fitting hood.4Centers Disease Control Prevention. Considerations optimizing supply https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/powered-air-purifying-respirators-strategy.html 28 April PAPRs higher assigned protection factor than FFP respirator. We sought investigate compatibility FFP3 loupes microscope, well examine logistics cleft under these conditions. group surgeons, paediatric dentists attended workshop National Surgical Clinical Skills Centre (NSCSC) Royal College Ireland 23 2020. Participants had opportunity try (Biztex Portwest, Westport, Mayo, Ireland) (3 M Scott, Monroe, North Carolina, USA). brought their own performed tasks skills lab, before joining anaesthetic nursing colleagues simulated room tracheostomy insertion, palate repair dental examination general anaesthesia. brief summary observations presented below. was run part ongoing study all specialties, initiated by UCD Precision Surgery, University Dublin, Ireland. This wider looked multiple factors relating usability laparoscopic procedures described here more detailed report combined data will elsewhere due course. respirator:•FFP3 tended cause facial discomfort PAPRs.•Only one type available day not participants could achieve adequate seal model. highlighted need variety brands/models/sizes theatres. Fit-testing training seal-checking staff members appropriately trained fitter required basis hospitals (it requirement EU regulation devices users fit-tested annually).•FFP3 sit regular masks, interfered correct positioning some participants.•The combination elasticated sports goggles comfortable using microscope (Figure 1). PAPR:•PAPRs were compatible microscope.•Spectacles, 2.5–3.0X prism-amplified worn 2). Spectacles necessitated full hood maintain around temple glasses.•Expanded field telescope loupe designs tips touched against visor, impeding bridge/nose pads loupes.•It felt switching respirator/goggles/microscope PAPR/facemask/loupes case (e.g. oral layer suturing following muscle dissection) would cumbersome time consuming.•While fit-testing necessary PAPRs, donning/doffing essential, space assistance prep rooms carry out processes safely. Operating simulation PAPRs:•Hearing verbal communication significantly hindered full-hood PAPRs.•There no difficulty patient down, inserting gag manoeuvres while both surgeon assistant wearing While public institutional guidelines decision-making use, it important options them subspecialty needs. explored several comfortably PPE. can anticipate learning curve starting operate needs accounted planning our return elective activity. test environment beneficial. Not required.