Controlling viral aerosols in COVID-19 and beyond

Protecting healthcare staff and preserving key clinical practice is a key WHO priority area for the immediate term in the COVID-19 pandemic, and also after peak crisis in the new practice landscape with population prevalence. Surgery is a key therapy for emergency patients and for cancer care and cardiac disease among others. It also is the hallmark aerosolising intervention, risking viral transmission to many staff, not only during the procedure itself, but also during other interventional procedures including bedside episodic procedures such as intubation for ventilation or nasogastric tube drainage. Recent guidance has suggested abandoning keyhole surgery access, despite its cornerstone role in emergency and cancer therapy, its myriad benefits to patients, and the fact that a whole generation of surgeons would need retraining in open surgery to accomplish this safely. Laparoscopic surgery uses gas to distend a body cavity to make space for a camera and instruments to be inserted and worked by a surgical team. This gas is emptied from the patient by opening valves in the access instrumentation which typically enters the operating room (OR). The risks of venting gas can be addressed technologically by using more sophisticated and emerging insufflation technology. However this does not address leaks during endotracheal tube placement, leaks that occur around the trocar, leaks during endoscopy or leaks from the anus during transanal surgery. This project will a) characterise the nature of these gas leaks using specialized imaging technology, b) develop vacuum devices to entrain and filter such leaks c) validate the effectiveness of the devices clinically, complete CE mark certification and e) deploy to surgery centres worldwide.