Abstract
Aerosols generated during endoscopic sinus procedures present a concern to the health and safety of healthcare personnel, especially with the presence of coronavirus disease (COVID-19). The purpose of this study is to describe the design and testing of a nasal cover to restrict aerosolized pathogens. The nasal cover was designed to sit overtop the nose with conformal slits for insertion of endoscopic instrumentation. Polydimethylsiloxane (PDMS) was chosen as the nasal mask material and its composition, thickness, and slit geometry were selected using a Taguchi experimental design and survey with clinical collaborators at Penn State Milton S. Hershey Medical Center. The nasal cover was designed using principles of origami engineering to be manufactured flat and then folded into its operating state. Form and functionality were evaluated by surgeons, fellows, and residents in the aforementioned survey. Aerosol containment was evaluated by measuring smoke, representative of surgical aerosols, with an optical particle counter. A 25:1 composition PDMS with 3 mm thickness and vertical slit geometry was chosen for the nasal cover design. Survey results demonstrated that the origami cover sat well on the nose and did not significantly impact the surgical conditions with single instrumentation. On average, this nasal cover was found to restrict more than 93% of 0.3 μm aerosols, and more than 99% of all aerosols larger than 0.5 μm in size. The use of a patient worn nasal cover has the potential to drastically reduce the risk to hospital personnel during endonasal surgeries by reducing aerosol generation and potential pathogen spread.
Issue Section:
Research Papers
References
1.
Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19)
, “Disease or Condition of the Week,” U.S. Department of Health and Human Services, Atlanta, GA, accessed Mar. 16, 2022, https://www.cdc.gov/dotw/covid-19/index.html2.
Liu
,
Y.
,
Ning
,
Z.
,
Chen
,
Y.
,
Guo
,
M.
,
Liu
,
Y.
,
Gali
,
N. K.
,
Sun
,
L.
,
Duan
,
Y.
,
Cai
,
J.
,
Westerdahl
,
D.
,
Liu
,
X.
,
Xu
,
K.
,
Ho
,
K. f.
,
Kan
,
H.
,
Fu
,
Q.
, and
Lan
,
K.
, 2020
, “
Aerodynamic Analysis of SARS-CoV-2 in Two Wuhan Hospitals
,” Nature
,
582
(7813
), pp. 557
–560
.10.1038/s41586-020-2271-33.
Lednicky
,
J.
,
Lauzard
,
M.
,
Fan
,
Z.
,
Jutla
,
A.
,
Tilly
,
T.
,
Gangwar
,
M.
,
Usmani
,
M.
,
Shankar
,
S.
,
Mohamed
,
K.
,
Eiguren-Fernandez
,
A.
,
Stephenson
,
C.
,
Alam
,
M.
,
Elbadry
,
M.
,
Loeb
,
J.
,
Subramaniam
,
K.
,
Waltzek
,
T.
,
Cherabuddi
,
K.
,
Morris
,
J.
, and
Wu
,
C.
, 2020
, “
Viable SARS-CoV-2 in the Air of a Hospital Room With COVID-19 Patients
,” Int. Soc. Infect. Dis.
,
100
, pp. 476
–482
.10.1016/j.ijid.2020.09.0254.
Azimi
,
P.
,
Keshavarz
,
Z.
,
Cedeno Laurent
,
J.
,
Stephens
,
B.
, and
Allen
,
J.
, 2021
, “
Mechanistic Transmission Modeling of COVID-19 on the Diamond Princess Cruise Ship Demonstrates the Importance of Aerosol Transmission
,” Proc. Natl. Acad. Sci. U. S. A.
,
118
(8
), p. e2015482118.10.1073/pnas.20154821185.
Fu
,
S. J.
,
George
,
E. L.
,
Maggio
,
P. M.
,
Hawn
,
M.
, and
Nazerali
,
R.
, 2020
, “
The Consequences of Delaying Elective Surgery: Surgical Perspective
,” Ann. Surg.
,
272
(2
), pp. e79
–e80
.10.1097/SLA.00000000000039986.
Wax
,
R.
, and
Christian
,
M.
, 2020
, “
Practical Recommendations for Critical Care and Anesthesiology Teams Caring for Novel Coronavirus (2019-NCoV) Patients
,” Can. J. Anesth.
,
67
(5
), pp. 568
–576
.10.1007/s12630-020-01591-x7.
Vukkadala
,
N.
,
Qian
,
Z.
,
Holsinger
,
F.
,
Patel
,
Z.
, and
Rosenthal
,
E.
, 2020
, “
COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review
,” Laryngoscope
,
130
(11
), pp. 2537
–2543
.10.1002/lary.286728.
Zacharia
,
B.
,
Eichberg
,
D.
,
Ivan
,
M.
,
Hanft
,
S.
,
Boockvar
,
J.
,
Isildak
,
H.
,
Mansouri
,
A.
,
Komotar
,
R.
, and
D'Amico
,
R.
, 2020
, “
Surgical Management of Brain Tumor Patients in the COVID-19 Era
,” Neurosurgery
,
87
(2
), pp. E197
–E200
.10.1093/neuros/nyaa1629.
Boccalatte
,
L.
,
Larrañaga
,
J.
,
Perez Raffo
,
G.
,
Teijido
,
C.
,
García Fornari
,
G.
,
Staneloni
,
M.
, and
Figari
,
M.
, 2020
, “
Brief Guideline for the Prevention of COVID-19 Infection in Head and Neck and Otolaryngology Surgeons
,” Am. J. Otolaryngol. Head Neck Med. Surg.
,
41
(3
), p. 102484
.10.1016/j.amjoto.2020.10248410.
Zou
,
L.
,
Ruan
,
F.
,
Huang
,
M.
,
Liang
,
L.
,
Huang
,
H.
,
Hong
,
Z.
,
Yu
,
J.
,
Kang
,
M.
,
Song
,
Y.
,
Xia
,
J.
,
Guo
,
Q.
,
Song
,
T.
,
He
,
J.
,
Yen
,
H.-L.
,
Peiris
,
M.
, and
Wu
,
J.
, 2020
, “
SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients
,” New Engl. J. Med.
,
382
(12
), pp. 1177
–1179
.10.1056/NEJMc200173711.
Bhattacharyya
,
N.
, 2010
, “
Ambulatory Sinus and Nasal Surgery in the United States: Demographics and Perioperative Outcomes
,” Laryngoscope
,
120
(3
), pp. 635
–638
.10.1002/lary.2077712.
Pynnonen
,
M. A.
, and
Davis
,
M. M.
, 2014
, “
Extent of Sinus Surgery, 2000 to 2009: A Population-Based Study
,” Laryngoscope
,
124
(4
), pp. 820
–825
.10.1002/lary.2433513.
Kennedy
,
D.
, and
Senior
,
B.
, 1997
, “
Endoscopic Sinus Surgery
,” Otolaryngol. Clin. North Am.
,
30
(3
), pp. 313
–330
.10.1016/S0030-6665(20)30212-714.
Tajudeen
,
B.
, and
Kennedy
,
D.
, 2017
, “
Thirty Years of Endoscopic Sinus Surgery: What Have We Learned?
,” World J. Otorhinolaryngol. Head Neck Surg.
,
3
(2
), pp. 115
–121
.10.1016/j.wjorl.2016.12.00115.
Workman
,
A.
,
Welling
,
D.
,
Carter
,
B.
,
Curry
,
W.
,
Holbrook
,
E.
,
Gray
,
S.
,
Scangas
,
G.
, and
Bleier
,
B.
, 2020
, “
Endonasal Instrumentation and Aerosolization Risk in the Era of COVID-19: Simulation, Literature Review, and Proposed Mitigation Strategies
,” Int. Forum Allergy Rhinol.
,
10
(7
), pp. 798
–805
.10.1002/alr.2257716.
Dharmarajan
,
H.
,
Freiser
,
M.
,
Sim
,
E.
,
Boorgu
,
D.
,
Corcoran
,
T.
,
Wang
,
E.
,
Gardner
,
P.
, and
Snyderman
,
C.
, 2021
, “
Droplet and Aerosol Generation With Endonasal Surgery: Methods to Mitigate Risk During the COVID-19 Pandemic
,” Otolaryngol. Head Neck Surg.
,
164
(2
), pp. 285
–293
.10.1177/019459982094980217.
LeConte
,
B.
,
Low
,
G.
,
Citardi
,
M.
,
Yao
,
W.
,
Eguia
,
A.
, and
Luong
,
A.
, 2020
, “
Aerosol Generation With Common Rhinologic Devices: Cadaveric Study Conducted in a Surgical Suite
,” Int. Forum Allergy Rhinol.
,
10
(11
), pp. 1261
–1263
.10.1002/alr.2267918.
Murr
,
A.
,
Lenze
,
N. R.
,
Brown
,
W. C.
,
Gelpi
,
M. W.
,
Ebert
,
C. S.
,
Senior
,
B. A.
,
Thorp
,
B. D.
,
Zanation
,
A. M.
, and
Kimple
,
A. J.
, 2021
, “
Quantification of Aerosol Particle Concentrations During Endoscopic Sinonasal Surgery in the Operating Room
,” Am. J. Rhinol. Allergy
,
35
(4
), pp. 426
–431
.10.1177/194589242096233519.
Workman
,
A.
,
Jafari
,
A.
,
Welling
,
D.
,
Varvares
,
M.
,
Gray
,
S.
,
Holbrook
,
E.
,
Scangas
,
G.
,
Xiao
,
R.
,
Carter
,
B.
,
Curry
,
W.
, and
Bleier
,
B.
, 2020
, “
Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations
,” Otolaryngol. Head Neck Surg.
,
163
(3
), pp. 465
–470
.10.1177/019459982093180520.
Sharma
,
D.
,
Campiti
,
V.
,
Ye
,
M.
,
Rubel
,
K.
,
Higgins
,
T.
,
Wu
,
A.
,
Shipchandler
,
T.
,
Burgin
,
S.
,
Sim
,
M.
,
Illing
,
E.
,
Park
,
J.
, and
Ting
,
J.
, 2021
, “
Aerosol Generation During Routine Rhinologic Surgeries and in‐Office Procedures
,” Laryngoscope Invest. Otolaryngol.
,
6
(1
), pp. 49
–57
.10.1002/lio2.52021.
Brüske-Hohlfeld
,
I.
,
Preissler
,
G.
,
Jauch
,
K. W.
,
Pitz
,
M.
,
Nowak
,
D.
,
Peters
,
A.
, and
Wichmann
,
H. E.
, 2008
, “
Surgical Smoke and Ultrafine Particles
,” J. Occup. Med. Toxicol.
,
3
(1
), pp. 31
–6
.10.1186/1745-6673-3-3122.
Carr
,
M.
,
Patel
,
V.
,
Soo
,
J.
,
Friend
,
S.
, and
Lee
,
E.
, 2020
, “
Effect of Electrocautery Settings on Particulate Concentrations in Surgical Plume During Tonsillectomy
,” Otolaryngol. Head Neck Surg.
,
162
(6
), pp. 867
–872
.10.1177/019459982091427523.
Sawchuk
,
W.
,
Weber
,
P.
,
Lowy
,
D.
, and
Dzubow
,
L.
, 1989
, “
Infectious Papillomavirus in the Vapor of Warts Treated With Carbon Dioxide Laser or Electrocoagulation: Detection and Protection
,” J. Am. Acad. Dermatol.
,
21
(1
), pp. 41
–49
.10.1016/S0190-9622(89)70146-824.
van Doremalen
,
N.
,
Bushmaker
,
T.
,
Morris
,
D.
,
Holbrook
,
M.
,
Gamble
,
A.
,
Williamson
,
B.
,
Tamin
,
A.
,
Harcourt
,
J.
,
Thornburg
,
N.
,
Gerber
,
S.
,
Lloyd-Smith
,
J.
,
de Wit
,
E.
, and
Munster
,
V.
, 2020
, “
Aerosol and Surface Stability of SARS-CoV-2 as Compared With SARS-CoV-1
,” New Engl. J. Med.
,
382
(16
), pp. 1564
–1567
.10.1056/NEJMc200497325.
Davies
,
J.
,
Chan
,
H.
,
Gilbert
,
R.
, and
Irish
,
J.
, 2020
, “
Nasal Endoscopy During the COVID-19 Pandemic: Mitigating Risk With 3D Printed Masks
,” Laryngoscope
,
130
(11
), pp. 2561
–2563
.10.1002/lary.2900426.
Narwani
,
V.
,
Kohli
,
N.
, and
Lerner
,
M.
, 2020
, “
Application of a Modified Endoscopy Face Mask for Flexible Laryngoscopy During the COVID-19 Pandemic
,” Otolaryngol. Head Neck Surg.
,
163
(1
), pp. 107
–109
.10.1177/019459982092897727.
Khoury
,
T.
,
Lavergne
,
P.
,
Chitguppi
,
C.
,
Rabinowitz
,
M.
,
Nyquist
,
G.
,
Rosen
,
M.
, and
Evans
,
J.
, 2020
, “
Aerosolized Particle Reduction: A Novel Cadaveric Model and a Negative Airway Pressure Respirator (NAPR) System to Protect Health Care Workers From COVID-19
,” Otolaryngol. Head Neck Surg.
,
163
(1
), pp. 151
–155
.10.1177/019459982092927528.
Helman
,
S.
,
Soriano
,
R.
,
Tomov
,
M.
,
Serpooshan
,
V.
,
Levy
,
J.
,
Pradilla
,
G.
, and
Solares
,
A.
, 2020
, “
Ventilated Upper Airway Endoscopic Endonasal Procedure Mask: Surgical Safety in the COVID-19 Era
,” Oper. Neurosurg.
,
19
(3
), pp. 271
–280
.10.1093/ons/opaa16829.
Hoffman
,
H.
,
Miller
,
R.
,
Walsh
,
J.
,
Stegall
,
H.
, and
Diekema
,
D.
, 2020
, “
Negative Pressure Face Shield for Flexible Laryngoscopy in the COVID ‐19 Era
,” Laryngoscope Invest. Otolaryngol.
,
5
(4
), pp. 718
–726
.10.1002/lio2.43730.
Sayin
,
İ.
,
Devecioğlu
,
İ.
, and
Yazıcı
,
Z.
, 2020
, “
A Closed Chamber ENT Examination Unit for Aerosol-Generating Endoscopic Examinations of COVID-19 Patients
,” Ear, Nose Throat J.
,
99
(9
), pp. 594
–596
.10.1177/014556132093121631.
Bianco
,
F.
,
Incollingo
,
P.
,
Grossi
,
U.
, and
Gallo
,
G.
, 2020
, “
Preventing Transmission Among Operating Room Staff During COVID-19 Pandemic: The Role of the Aerosol Box and Other Personal Protective Equipment
,” Updates Surg.
,
72
(3
), pp. 907
–910
.10.1007/s13304-020-00818-232.
David
,
A.
,
Jiam
,
N.
,
Reither
,
J.
,
Gurrola
,
J.
,
Aghi
,
M.
, and
El-Sayed
,
I.
, 2020
, “
Endoscopic Skull Base and Transoral Surgery During COVID-19 Pandemic: Minimizing Droplet Spread With Negative-Pressure Otolaryngology Viral Isolation Drape
,” Head Neck
,
42
(7
), pp. 1577
–1582
.10.1002/hed.2623933.
Bertroche
,
J. T.
,
Pipkorn
,
P.
,
Zolkind
,
P.
,
Buchman
,
C. A.
, and
Zevallos
,
J. P.
, 2020
, “
Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy
,” JAMA Otolaryngol. Head Neck Surg.
,
146
(7
), p. 672
.10.1001/jamaoto.2020.108134.
Anon
,
J.
,
Denne
,
C.
, and
Rees
,
D.
, 2020
, “
Patient-Worn Enhanced Protection Face Shield for Flexible Endoscopy
,” Otolaryngol. Head Neck Surg.
,
163
(2
), pp. 280
–283
.10.1177/019459982093477735.
Edmondson
,
B. J.
,
Bowen
,
L. A.
,
Grames
,
C. L.
,
Magleby
,
S. P.
,
Howell
,
L. L.
, and
Bateman
,
T. C.
, 2013
, “
Oriceps: Origami-Inspired Forceps,” Volume 1: Development and Characterization of Multifunctional Materials; Modeling, Simulation and Control of Adaptive Systems; Integrated System Design and Implementation
,” ASME
Paper No. SMASIS2013-3299.10.1115/SMASIS2013-329936.
Freddi
,
A.
, and
Salmon
,
M.
, 2019
, Design Principles and Methodologies
,
Springer Nature Switzerland AG
,
Cham, Switzerland
, Chap. 7
.37.
Gordon
,
C.
,
Churchill
,
T.
,
Clauser
,
C.
,
Mcconville
,
J.
,
Tebbetts
,
I.
, and
Walker
,
R.
, 1989
, “1988 Anthropometric Survey of U. S. Army Personnel Methods and Summary Statistics”, ANSUR, Natick, MA, Report No. Natick/TR-89/044
.https://global.ihs.com/doc_detail.cfm?document_name=NAT ICK%20T R%2089%2D044&item_s_key=0022647738.
Bowen
,
L.
,
Springsteen
,
K.
,
Ahmed
,
S.
,
Arrojado
,
E.
,
Frecker
,
M.
,
Simpson
,
T. W.
,
Ounaies
,
Z.
, and
Lockette
,
P. v.
, 2017
, “
Design, Fabrication, and Modeling of an Electric-Magnetic Self-Folding Sheet
,” ASME J. Mech. Rob.
,
9
(2
), pp. 1
–13
.10.1115/1.403596639.
Bowen
,
L.
,
Springsteen
,
K.
,
Feldstein
,
H.
,
Frecker
,
M.
,
Simpson
,
T. W.
, and
von Lockette
,
P.
, 2015
, “
Development and Validation of a Dynamic Model of Magneto-Active Elastomer Actuation of the Origami Waterbomb Base
,” ASME J. Mech. Rob.
,
7
(1
), pp. 1
–10
.10.1115/1.402929040.
Howell
,
L. L.
, 2001
, Compliant Mechanisms
,
Wiley-Interscience
,
Hoboken, NJ
.41.
Tansel
,
D. Z.
,
Brenneman
,
J.
,
Fedder
,
G. K.
, and
Panat
,
R.
, 2020
, “
Mechanical Characterization of Polydimethylsiloxane (PDMS) Exposed to Thermal Histories Up to 300 C in a Vacuum Environment
,” J. Micromech. Microeng.
,
30
(6
), p. 067001
.10.1088/1361-6439/ab82f442.
Li
,
C.
,
Jiang
,
J.
,
Dong
,
H.
, and
Zhao
,
K.
, 2017
, “
Computational Modeling and Validation of Human Nasal Airflow Under Various Breathing Conditions
,” J. Biomech.
,
64
, pp. 59
–68
.10.1016/j.jbiomech.2017.08.03143.
Zhao
,
K.
, and
Jiang
,
J.
, 2014
, “
What is Normal Nasal Airflow? A Computational Study of 22 Healthy Adults
,” Int. Forum Allergy Rhinol.
,
4
(6
), pp. 435
–446
.10.1002/alr.2131944.
Cheng
,
Y.
,
Bechtold
,
W.
,
Yu
,
C.
, and
Hung
,
I.
, 1995
, “
Incense Smoke: Characterization and Dynamics in Indoor Environments
,” Aerosol Sci. Technol.
,
23
(3
), pp. 271
–281
.10.1080/0278682950896531245.
O'Grady
,
B. J.
,
Geuy
,
M. D.
,
Kim
,
H.
,
Balotin
,
K. M.
,
Allchin
,
E. R.
,
Florian
,
D. C.
,
Bute
,
N. N.
,
Scott
,
T. E.
,
Lowen
,
G. B.
,
Fricker
,
C. M.
,
Fitzgerald
,
M. L.
,
Guelcher
,
S. A.
,
Wikswo
,
J. P.
,
Bellan
,
L. M.
, and
Lippmann
,
E. S.
, 2021
, “
Rapid Prototyping of Cell Culture Microdevices Using Parylene-Coated 3D Prints
,” Lab Chip
,
21
(24
), pp. 4814
–4822
.10.1039/D1LC00744K46.
Kim
,
Y. G.
,
Lim
,
N.
,
Kim
,
J.
,
Kim
,
C.
,
Lee
,
J.
, and
Kwon
,
K. H.
, 2019
, “
Study on the Surface Energy Characteristics of Polydimethylsiloxane (PDMS) Films Modified by C4F8/O2/Ar Plasma Treatment
,” Appl. Surf. Sci.
,
477
, pp. 198
–203
.10.1016/j.apsusc.2017.11.009Copyright © 2022 by ASME
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