Background: Otolaryngologists represent a subset of health care workers uniquely vulnerable to COVID-19 transmission. Given the segmentation of extant guidelines concerning precautions and protective equipment for SARS-CoV2, we aimed to provide consolidated recommendations regarding appropriate personal protective equipment (PPE) in head neck surgery during the COVID-19 era.
Methods: Guidelines published by international and US governing bodies were reviewed in conjunction with published literature concerning COVID-19 transmission risk, testing, and PPE, to compile situation-specific recommendations for head and neck providers managing COVID-19 patients.
Results: High-quality data regarding the aerosolization potential of head and neck instrumentation and appropriate PPE during head and neck surgeries are lacking. However, extrapolation of recommendations by governing bodies suggests strongly that head and neck mucosal instrumentation warrants strict adherence to airborne-level precautions.
Conclusion: We present a series of situation-specific recommendations for PPE use and other procedural precautions for otolaryngology providers to consider in the COVID-19 era.
Keywords: COVID-19; high-risk procedures; perioperative protocols; personal protective equipment.
© 2020 Wiley Periodicals, Inc.
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- COVID-19 Map. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html. Accessed April 14, 2020.
- Lau JTF, Fung KS, Wong TW, et al. SARS transmission among hospital workers in Hong Kong. Emerg Infect Dis. 2004;10(2):280-286. https://doi.org/10.3201/eid1002.030534.
- Ranney ML, Griffeth V, Jha AK. Critical supply shortages - the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020; 382:e41. https://doi.org/10.1056/NEJMp2006141.
- Bourouiba L. A sneeze. N Engl J Med. 2016;375(8):e15. https://doi.org/10.1056/NEJMicm1501197.
- van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020; 382(16):1564-1567. https://doi.org/10.1056/NEJMc2004973.