A preliminary evaluation of surgical field contamination risk from surgeon's oro-nasopharyngeal commensal organisms while using reusable FFP3 respirator masks and power hoods with relevance to the COVID 19 pandemic - A pilot study.

In early 2019 in the UK, concern about the risk of COVID-19 transmission to surgeons who operate near to the airway led to wide scale adoption of different masks, including valved types used in industry. It was noted early on that although these masks protect clinicians, they may represent a risk to the patient due to unfiltered air being directed towards them during close contact1 and the National Health Service circulated guidance to that effect2. Subsequently, an increased incidence of surgical site infection (SSI) was noticed, postulated to be due to contamination of the surgical field by microbial particles from valved masks or hoods leading to a National Patient Safety Alert3. A study recommended that a surgical mask be placed over the exhaust valves of these mask types4. We reviewed the literature using the key words surgical masks, power hoods, FFP3 masks and surgical site infection. Most studies showed no reduction in the incidence of SSI with surgical masks5, but some showed an increase6. There were no studies comparing bacterial contamination of the surgical site with different types of masks. A pilot study was designed to evaluate if FFP3 respirators and powerhoods allowed bacterial contamination of the surgical field in comparison with standard surgical masks and no masks. The results appeared to confirm our methodology and suggested that reusable valved FFP3 masks are associated with bacterial dissemination. Subsequent examination of these masks identified a potential mechanism for this bacterial contamination. A larger scale study is needed.

The impact of COVID-19 on cleft services in Great Britain & Northern Ireland.

INTRODUCTION: Cleft lip and/or palate is the most common craniofacial anomaly and occurs in 1 in 650 to 700 live births in the United Kingdom (UK). The majority of cleft surgery is elective, and as a result, almost all cleft surgery was suspended across the UK in March 2020 during the first national lockdown. The UK has centralised regional Cleft Services which all use the same agreed target-age standards for primary surgery including lip and palate repairs. The coronavirus disease-2019 (COVID-19) response has caused a delay in carrying out procedures. The severity of this delay depends on the impact of COVID-19 on local trusts and R-value within that region. As the country goes through the second and third wave, the impact could be long lasting, and we aimed to quantify it so that the data could be used to guide service prioritisation in the NHS and help future workforce planning. METHODS: An online survey was designed based on the cleft quality dashboard indicators and circulated nationally to all nine cleft regions in the UK. The survey was divided into three main headings: • Duration of suspended cleft services • Quantification of the impact on delayed in surgery/services • Changes needed to restart surgery/services RESULTS: We obtained a 60% response rate with five completed surveys from five out of nine regions. All regions reported that they suspended their cleft services in March 2020 around the time of the first wave and the first national lockdown. There has been an impact on delayed surgical and clinical interventions for cleft patients. Regions were affected differently with some on an exponential waiting list growth projection, whereas other teams are on track to recover from the backlog within 7-22 weeks. There has been an impact on the allied health professionals' services within the cleft multidisciplinary team. The cleft nurses' 24-h reviews, Speech And Language Therapy (SALT), and psychology maintained service delivery in some format. Patient-facing services such as audiology and dentistry were significantly disrupted and continue to experience delays due to reduced capacity. CONCLUSIONS: Various regions have seen a varied impact from COVID-19 on their services, from all cleft regions there seems to be an impact on achieving surgery within the national target age. The adverse effect of the COVID-19 impact is unlikely to be known for a few years to come; however, the data are a useful guide when supporting the allocation of resources within the healthcare setting. A prospective long-term study is required to assess the impact of COVID-19 on cleft surgery, follow-up, assess access to allied health professional MDT clinics, and long-term complications.