Concerned about Aerosol Generating Procedures (AGPs)?

Me too. They have been on my mind in the last few weeks. So I, like many others, have been seeking this ever-elusive piece of kit. The ULTIMATE mask.

Essential qualities: comfortable to wear, usable with glasses/loupes (and a head light plus a visor if that’s not pushing my luck) and 100% impregnable to THE virus. Unlike Batman’s, it actually needs to cover my nose and mouth.

Desirable qualities: easy to exhale through, anti-fog (what’s the point of loupes if you can’t see through them?) and not too bulky (thus avoiding inevitable head clashes with other team members and the light).

There is also the valve conundrum1. Valve positive masks are not people friendly as the wearer exhales towards the patient. Valve negative masks are not surgeon friendly and result in eyewear steaming up and moisture collecting between the mask and the operator’s face. I generally find it helpful to see what I am doing and I suspect my patients do as well. So not Spiderman’s either.

My first experiment was with FFP2 masks – comfortable and valve-less seemingly without too much fogging up but this led me to suspect the seal was not 100% and, of course, they weren’t much good for AGPs. This led on to two types of disposable FFP3 masks – one heavy duty builder’s type – definitely impregnable but try as I might, my loupes would not sit properly and I’m not skilled enough to operate whilst seeing double. The second FFP3 type was much more comfortable but (small snag) dated to expire in 2016 – helpfully this date had been extended (with a sticker) to 2019 but this didn’t instil huge confidence. And they seemed to pass the fit test so they were reasonably virus-impregnable. Probably. And I could wear loupes with them – but they did have a valve.

The final respirator mask I have tried is really hard core. There ain’t nothing getting through this baby. I do sound alarmingly like Darth Vader though and breathing isn’t easy. Not terribly reassuring for my poor patients. It also has a valve – which needs to be covered by a surgical mask – producing moisture collection underneath and an interesting aqua-plane type effect whereby the mask slides around on my face. The seal holds though but it does need removing and cleaning at regular intervals. Defeating the point, perhaps?

All this on the assumption that picking up a surgical handpiece equates to an Aerosol Generating Procedure (AGP). Looking through the literature, I found a good summary from NHS Scotland2. High speed dental drills are categorised as AGPs as are ‘upper ENT airway procedures that involve suctioning’ but no mention of surgical handpieces or slow speed drills. So the FFP2 should be OK for Oral Surgery. Probably. Maybe. Hmmm – I think I’ll stick to my respirator for now.

Rebecca Hierons, Immediate Past President of BAOS