Surgical face shields are worn as routine personal protective equipment (PPEs) by the surgeons during joint replacement surgeries to prevent periprosthetic joint infections. Each surgical face shield costs around 1100 INR to 1800 INR and to be worn by everyone in the operating team, further burdening the healthcare system. These surgical face shields prevent the operating team from aerosols/microdroplets to some extent.
The filtration material of surgical face shield is in standards with ASTM F2100 Level 1 which signifies that the sub micron particulate filtration efficiency at 0.1 micron is ≥ 95%.7
However, the supporting staff and anaesthetic team are at high risk for infection by aerosols. As per the guidelines developed by the INTERNATIONAL CONSENSUS GROUP (ICM) headed by Javad Parvizi surgical face shields are not recommended to use routinely for the unconfirmed cases during this pandemic, the reasons being the surgical helmets and fans in it can harbour viruses and they can't be sterilized regularly and in between the procedures.7 This acts as a potential source of infection from patient to surgeon and between surgeons and from surgeon to the next patient.8
ICM group also recommends the use of protective eyewear that provides a seal around the eyes (eg: goggles) along with a mask (preferably N95, FFP2 or P3 with expiratory valve) in the absence of surgical face shield.8
Furthermore, there is a huge gap in supply and demand globally due to COVID 19 pandemic. Because of the surge in demand and low availability in protective gear, new standard operating procedures should put forth to meet the crises.9
With the use of surgical face shields as a barrier directly over the surgical field as we described in our technique not only reduces aerosol dissemination contaminating the operating theatre but also cost-effective further reducing the economic and social burden to the patient and healthcare system.
We have come up with this novel way to protect ourselves and our team members in these unprecedented times. The aim of this paper is to share our technique with other orthopaedic colleagues and help them and their teams to stay safe.