Recommendations for personal protective equipment and smoke evacuation for dermatologic surgeries amid the COVID-19 crisis

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly affected clinical practices. Currently, elective dermatologic procedures (ablative laser procedure and laser hair removal) are deferred with only emergency dermatological surgeries being performed to lessen viral spread and preserve personal protective equipment (PPE). As COVID-19 prevalence decreases, postponed procedures will be scheduled. For Mohs micrographic surgery (MMS) and excisions, hemostasis is often achieved by electrosurgery, generating surgical smoke plume. Although data on transmission of SARS-CoV-2 via surgical smoke is unavailable, human immunodeficiency virus, hepatitis B virus, and human papillomavirus have been detected in surgical smoke. Since SARS-CoV-2 may be transmitted through aerosols, it is critical to reexamine recommended protective measures for dermatologic surgery. Since COVID-19 is transmitted through droplets and aerosols,2 it is premature to resume elective laser procedures, including ablative CO2 and hair removal. However, deferred non-elective excisions and MMS for skin cancer will need to be performed in the near future. The Centers for Disease Control and Prevention (CDC) recommends N95 respirator use for health care workers participating in aerosol-generating procedures (AGP). Therefore, N95 respirators are essential for dermatologic surgeons and staff operating on mucosal regions and/or generating aerosols with electrocautery. The CDC recommends against extended use or reuse of respirators following AGP. However, given N95 shortages, particularly in outpatient dermatology practices, following this recommendation may be unrealistic, with extended use unavoidable. A surgical mask covering the N95 respirator may be considered to extend longevity. Decontamination of N95s for reuse3 or 3D-printed masks have also been proposed;testing would be required to ensure effective filtration. Many hospitals are adequately supporting redeployed resident and attending dermatologists caring for COVID-19 inpatients. As people are discharged from redeployments and perform increasing numbers of essential outpatient dermatological surgeries, it is incumbent upon hospitals, as well as, state and federal governments to ensure adequate access to PPE for all dermatologists and staff.