New PPE allows us to perform surgery on deaf children

With so many operations put on hold when the pandemic started in March, surgeon Douglas Hartley and a team of medical veterans got to work pioneering new types of protective equipment.

When the coronavirus pandemic first hit the UK, thousands of surgical procedures were put on hold. For surgeons like Douglas, who performs operations on deaf children to restore their hearing, this created a significant moral dilemma – he wanted to get back into surgery to provide this vital care, but didn’t want to inadvertently catch or pass on COVID-19 in the process.

Douglas regularly carries out cochlear implant surgery, a process in which a surgeon embeds an electronic device which stimulates the hearing nerve in the ear. The scientific evidence is clear that this surgery needs to be performed at the earliest opportunity so that these children can benefit from being able to hear at a vital stage in their development.

But performing the surgery as normal would have put both children and surgical teams in danger. They needed to come up with another way of doing things. The team in Nottingham had to combine creativity and science to develop a novel and safe way to restart cochlear implant surgery in a matter of just a few weeks.

The team used a systematic evidence-based approach to evaluate a variety of PPE for its usability and effectiveness. During simulated cochlear implant surgery, they evaluated each type of PPE across several parameters, including its effect on a surgeon’s ability to communicate, their field of vision, and their comfort.

Many of the PPE options were found to substantially restrict the surgeon’s vision during operating. That rendered them unsafe for performing this sort of surgery. Instead, they found that the combination of “spoggles” and a half-face respirator mask had consistently superior performance across all aspects of clinical usability compared with all other options.

During their studies, Douglas and his team also worked with a surgical product manufacturer to develop a novel drape, basically a tent, that was designed to be suspended from a microscope covering the patient’s head and torso to provide a physical barrier between the site of drilling and the rest of the team.

They found that the operating tent significantly contained the droplets and prevented them from spreading around the theatre environment. They are the first – and are currently only – group in the world to develop an operating tent design that is marked for medical use. After completing our studies, we now had appropriate PPE and a protective operating tent to permit the safe restarting of cochlear implant surgery during the pandemic.

These recommendations were rapidly disseminated internationally via webinars and journal publications and quickly adopted as standard patient care by Nottingham University NHS Foundation Trust and, subsequently, embraced in other departments in the UK and across the world.

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Source: The Independent, 22 October 2020