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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 90-91

Indigenous method to prevent aerosol dissemination while bone drilling using powered drill during COVID-19


1 Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Otorhinolaryngology, All India Institute of Medical Sciences, Patna, Bihar, India

Date of Submission24-Jun-2020
Date of Decision15-Jul-2020
Date of Acceptance25-Jul-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Sudeep Kumar
Department of Orthopaedics, All India Institute of Medical Sciences, Patna - 801 505, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODP.JODP_19_20

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  Abstract 


Introduction: World is now faced with a pandemic caused by Covid-19 causing unprecedented burden on the healthcare systems of the countries. As everyone is at the risk of exposure and contracting the infection, recent evidences started stating possible modes of transmission including aerosol. Aerosol generation is very common in surgical procedures, especially in orthopaedic trauma where the usage of electrocautery and powered drill are abundantly used. The purpose of this article is to describe how we used the barrel of syringe to decrease aerosol dissemination while drilling bone. Material and Methods: 50 and 20ml syringes were used during drilling in orthopaedic surgeries in consecutive patients. Observations and results: The spread of aerosol generation was found to reduce. Conclusion: It is a cheap and viable method to reduce the dissemination of aerosol during Covid pandemic.

Keywords: Aerosol generation, bone drilling, COVID-19


How to cite this article:
Kumar S, Charan Teja K V, Kumar A, Bhavana K. Indigenous method to prevent aerosol dissemination while bone drilling using powered drill during COVID-19. J Orthop Dis Traumatol 2020;3:90-1

How to cite this URL:
Kumar S, Charan Teja K V, Kumar A, Bhavana K. Indigenous method to prevent aerosol dissemination while bone drilling using powered drill during COVID-19. J Orthop Dis Traumatol [serial online] 2020 [cited 2020 Oct 21];3:90-1. Available from: https://www.jodt.org/text.asp?2020/3/2/90/294729




  Introduction Top


Coronavirus disease (COVID-19) is a highly transmittable and pathogenic viral infection, with rapid human-to-human transfer has been confirmed widely.[1] According to current evidence, the COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes.[2] With the awareness and understanding of the disease, the guidelines show that aerosol transmission is possible under the condition of long exposure to high concentrations of aerosols in a relatively closed environment.[3] What is more alarming is that aerosol is generally not visible and can be airborne for longer duration and travel longer distances than the droplets or droplet nuclei, thus posing a significant danger to health-care providers. Moreover, in a study by Jewett et al., it is proven that surgical equipment such as bone saw, drills, and electrocautery when used produce blood-containing aerosol particles in respirable range (<5 μ).[4] The disease spreads through droplet/aerosol transmission or on contact with the person or fomites. Orthopedic specialty is known for using highly powered equipment such as drills, saws, reamers, and electrocautery. The generation of aerosols during the procedures is high. It has been shown that bone drilling or burring, an integral part in orthopedics practice, causes aerosol generation, and the generated aerosol can go up to 6 m in the vicinity. In this article, we aim to give an insight into the ways of preventing the infection contraction and minimizing the aerosol generation, especially when drilling of bone is being done. When aerosol-generating procedures have to be carried out, we have devised an inexpensive technique that can potentially decrease the spread of aerosol generation by many folds, thereby reducing the risk of infection transmission to the surgical team and other personnel inside the operating room. The need for newer techniques and ideas that can decrease the transmission and protect the health-care workers cannot be overemphasized, as we all know there is no definitive treatment or vaccine for the prevention of COVID-19 as of now. In orthopedic practice, especially in the current scenarios, a lot of acute injuries and diseases can be managed conservatively, which has little difference in the outcomes. There are few scenarios in which surgery is the only treatment or the results of conservative management will have detrimental outcome for the patient. When faced with such conditions, surgeons should be very careful in deciding when to operate and ways to protect themselves and their team from exposure risk.


  Technical Tip and Trick Top


Using a powered drill to drill bone during surgery will generate aerosol and currently, there are no effective ways to prevent the generation or dissemination of aerosol. Hence, we have come up with a simple idea using instruments already available with us to decrease the dissemination of aerosol. A 50-ml and 20-ml disposable syringes with their front ends cut were used. They can be either cut freshly during the surgery or can be prepared beforehand and sterilized using appropriate technique available (e.g., plasma sterilized or Ethylene Oxide ETO). We recommend preparing it beforehand and keeping ready in cases where drilling is needed. Removing the marking is important for better visualization of the field. We have found that simply rubbing it with alcohol-based hand rub-soaked gauze piece will remove all the markings.

During drilling, the syringe can be used as a sleeve, with the cut end resting on the plate and the drill bit passing through the syringe [Figure 1] and [Figure 2]. This way, we can prevent the spread of aerosol to sides which normal drilling will create. This setup can be made still effective by keeping a wet gauze piece near the base of the syringe.
Figure 1: As the barrel of the syringe is transparent, there will not be much discomfort while using this for drilling. A single person can hold and drill so that the assistant can move away temporarily momentarily

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Figure 2: A generic 50-mL syringe has a barrel wide enough to accommodate the attachment of standard drills like stryker system 7 used in the image, without affecting its rotation. This will facilitate in easy adjustment of the length of the drill bit as per preference

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To save time, prepare the syringe beforehand and sterilize it appropriately as per available facilities.


  Indications Top


Any fracture which requires open reduction and internal fixation with plating.


  Potential Problems/limitations Top


Cutting the front part of the syringe may not be very easy, it should be done with a very sharp instrument or kitchen knife and carefully. It has to be done beforehand and the material is to be sterilized either by plasma sterilizer or by an ETO. It is not possible to use any type of drill guide with this technique. Thus, it may cause a potential problem if the drill holes have to be perfectly made in a centric or eccentric manner. There may be a potential conflict in cases where one wants to drill the hole very close to any clamp (bone holding or plate holding) applied to the bone using the syringe as a cover (as shown in the [Figure 1]).


  Strength of This Technique Top


It can be used by anyone around the world without any extra expenditure. Stuff like syringe is available in every theater.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. Covid-19 Infection: Origin, Transmission, and Characteristics of Human Coronaviruses. J Adv Res 2020;24:91-8.  Back to cited text no. 1
    
2.
Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations.   Back to cited text no. 2
    
3.
The National Health Commission of the People's Republic of China. Available from: http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml. [Lase accessed on 2020 May 20].  Back to cited text no. 3
    
4.
Jewett DL, Heinsohn P, Bennett C, Rosen A, Neuilly C. Blood-containing aerosols generated by surgical techniques: A possible infectious hazard. Am Ind Hyg Assoc J 1992;53:228-31.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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