How This Healthcare Team Maintained a Head and Neck Cancer Surgical Practice During COVID-19

Patients were assessed again on the day of their visit upon entry to the cancer center. Screening included temperature checks and scripted questions pertaining to sick contacts and COVID-19-related symptoms, including dysgeusia and anosmia. Emphasis was placed on screening both asymptomatic and symptomatic patients. These various screening events allowed for multiple points of patient education and intervention, while also reinforcing the importance of virus-related precautions.

Above and Beyond Standard Precautions

While face masks were permissible during socially distanced nonpatient work, N95 masks and eye protection were required for all team members for every patient visit and procedure done in the clinic. Further precautions included protective gowns, face shields, and in-room air scrubbers for higher-risk aerosol-generating procedures.

During procedures, only critical team members were permitted in the rooms; the senior-most team member performed the procedures to reduce time and risk of aerosol generation. Following each clinic procedure, the room was cleaned according to hospital infection control policies, including the use of disinfectant on surfaces and the use of an in-room air scrubber with high efficiency particulate air (HEPA) filter, which was an extra precaution on top of what was required.

Noncritical team members exited the operating room during intubation and extubation, as it was considered a major aerosol-generating procedure. The surgical team waited outside the operating room for six minutes to allow aerosolized particles to settle after intubation. All operating room team members wore N95 or equivalent respirators under standard surgical masks for surgeries that involved the upper aerodigestive tract.

Our team’s experience demonstrates that it’s possible to maintain a high-volume head and neck practice during the pandemic. These precautions reduce the risk of virus transmission and maintain the safety of patients and healthcare personnel.

Faisal Ahmad, MD, is a head and neck surgical oncologist; April D. Starling, DNP, RN, is a nurse manager; Palma D. Iacovitti, DNP, MBA, RN, is the program manager for surgical oncology clinics; and Russell B. Smith, MD, is the chief of the section of head and neck surgical oncology at Baptist MD Anderson Cancer Center.