Reducing droplets and aerosols in the surgical setting and applications to the COVID-19 pandemic

The COVID-19 pandemic brought a serious threat to healthcare providers in addition to the general population. Aerosols and droplets have been described as vehicles for SARS-CoV-2 transmission. Professionals in direct contact with nasal mucosa, oral cavity, oropharynx, and the upper and lower respiratory tract are at higher risk for exposure than the general population. In the surgical setting, strict measures should be taken to reduce environmental contamination. Different strategies in the operating room are recommended, such as ventilation systems guaranteeing an ultraclean environment by the removal of the existing air in the theater (unidirectional air flow) and negative pressure instead of the regular positive pressure to avoid contaminating other surgical areas. Personal protective equipment is mandatory when assisting a suspected or positive COVID-19 patient. To reduce aerosol exposure in the operating room in this pandemic era, several devices have been developed for different surgical specialties. There are several aerosol-generating medical procedures with which healthcare providers should be extra careful. Some of them are endotracheal intubation, tracheostomy, or sinus and skull base surgery, as during these procedures, secretions could be produced with consequent environmental contamination. The purpose of this chapter is to review different strategies to reduce aerosol and droplets exposure during aerosol-generating medical procedures.