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Procedural dermatology in the COVID-19 era: an online survey of the Philippine Dermatological Society members and practical recommendations for safe practice

Dim-Jamora, Krisinda Clare C.; Jamora, Maria Jasmin J.; Yu, Jonathan Nevin T.; and Dayrit, Johannes F.

Abstract

Background

The novel COVID-19 (Coronavirus Disease 19) predisposes the general population to a high risk of infection. The 106 million population of the Philippines would be considered an at-risk group due to the high density of the populace in cities. As the situation in each country differs during this era of the COVID-19 pandemic, this paper aims to give practical recommendations for safe procedural dermatology practice in the Philippine setting after the lifting of the government-mandated quarantine.

 

Methods

An online survey was conducted among Philippine Dermatological Society (PDS) members. The survey was sent electronically on March 22, 2020.

Results

A total of 466 or 42% of the PDS’s 1100 current members replied to the survey. The top 10 procedures performed among the respondents are: 1. Electrocautery (N=437, 94.38%), 2. Chemical peeling (N=422, 91.13%), 3. Laser & energy based device treatment (N= 341, 73.65%), 4. Botulinum toxin injection (N=323, 69.76%), 5. Excision (N=263, 56.80%), 6. Acne surgery (N=176, 38.01%), 7. Injectable Filler (N=171, 36.93%), 8. Cryotherapy (N=145, 31.32%), 9. Platelet rich plasma injection (N=111, 23.97%) and 10. Scar revision (N=85, 18.36%).

The majority of the respondents have access to personal protective equipment (PPE) such as surgical masks (N=457, 98.7%), face shields (57.67%), goggles
(46.00%), protective gown (42.76%) and bonnets (32.83%). Before the government quarantine, the majority (N=375, 81.17%) of respondents see patients on a
first-come, first-serve system. Only 18.83% (N=87) see patients only by appointment.

Regarding teledermatology, most respondents answered that they would advise patients to do digital consultation with only a minority responding they would not consider doing teledermatology.

Conclusions

Practical recommendations for surgical, procedural dermatology, laser surgery, and aesthetic procedural dermatology practice in the Philippines
include the following:

  1. Education of staff and patients on proper exposure prevention and sanitation measures.
  2. Ensuring the correct usage of PPE.
  3. Ensuring physical distancing and reducing patient wait times by scheduling visits on an appointment basis.
  4. Sufficient protocols must be made for sanitation before and after each patient visit.
  5. Teledermatology in pre-procedure consults and post-procedure follow-ups would reduce the risk of COVID-19 transmission for both patient and physician.

 

References

  1. “COVID-19 Case Tracker” (2020) Department of Health. Available from: https://www.doh.gov.ph/covid-19/case-tracker. Accessed April 15, 2020.
  2. Peng X, Xu X, Li Yuqing et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J of Oral Science (2020)12:9.
  3. Adhikari SP, Meng S, Wu YJ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020;9(1):29.
  4. “Cleaning and disinfection of environmental surfaces in the context of COVID-19: Interim guidance 15 May 2020 ” (2020) World Health Organization. Available from: https://apps.who.int/iris/handle/10665/332096. Accessed April 15, 2020.
  5. Wang LS, Wang YR, Ye DW, Liu QQ. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. Int J Antimicrob Agents. 2020:105948.
  6. Guo Z-D, Wang Z-Y, Zhang S-F, Li X, Li L, Li C, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis. 2020 Jul
  7. Islam MS, Rahman KM, Sun Y et al. Examining the Current Intelligence on COVID-19 and Infection Prevention and Control Strategies in Health Settings: A Global Analysis. Infect Control Hosp Epidemiol 2020 May 15;1-29.
  8. “Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19”. (2020) Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesmenthcp.html. Accessed April 15, 2020
  9. Arons MM, Hatfield KM, Reddy SC et al. Pre-symptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. NEJM 2020: 1-10 (April 24, 2020, NEJM.org)
  10. Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility – King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-381.
  11. “Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States”. (2020) Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html. Accessed April 7, 2020.
  12. Sanchez MJ. (2019) Number of mobile phone internet users in the Philippines from 2017 to 2023. Statista. Available from: https://www.statista.com/statistics/467186/forecast-of-smartphone-users-in-thephilippines/
  13. “The Educational Attainment of the Household Population (results from the 2010 Census). (2013) The Republic of the Philippines Philippine Statistics Authority. Available from: https://psa.gov.ph/content/educational-attainment-household-population-results-2010-census. Accessed April 7, 2020.
  14. “How to Protect Yourself and Others.” (2020) Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html. Accessed on: April 4, 2020
  15. Karuppal R, Surendran S, Patinharayil G et al. It is time for a more cautious approach to surgical diathermy, especially in COVID-19 outbreak: A schematic review. Journal of Orthopaedics. July-August 2020 (20): 297-300.
  16. Katoch S, Mysore V. Surgical smoke in Dermatology: Its hazards and management. J Cutan Aesthet Surg 2019;12:1-7.
  17. Mowbray NG, Ansell J, Horwood J et al. Safe Management of Surgical Smoke in the Age of COVID-19. Br J Surg 2020. May 03 (Online ahead of print) Published online in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.11679
  18. “What you Need to Know About Surgical Smoke Plumes “ (2019). Available from: http://www.boviemedical.com/2016/02/01/what-youneed-to-know-about-surgical-smoke-plumes/. Accessed on May 28, 2020.
  19. Stratton M. (2017) “Surgical Smoke Transmits Infectious Diseases; Here’s How to Stop It.” Available from: https://www.infectioncontroltoday.com/operating-room/surgical-smoke-transmits-infectious-diseasesheres-how-stop-it. Accessed on May 28, 2020.
  20. “Healthcare Facilities: Preparing for Community Transmission” (2020). Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html. Accessed on May 21, 2020.
  21. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA [Internet] 2020; available from: https://jamanetwork.com/journals/jama/fullarticle/2762130
  22. “List N: Disinfectants for Use Against SARS-CoV-2” (2020). United States Environmental Protection Agency. Available at: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2. Accessed on April 30, 2020.
  23. Lewin JR, Brauer JA and Ostad A. Surgical smoke and the dermatologist. J Am Acad Dermatol 2011;65:636-41
  24. “Understanding and controlling the hazards of surgical smoke.” (2011) Becker’s ASC Review. Available from: https://www.beckersasc.com/ascaccreditation-
    and-patient-safety/understanding-and-controlling-thehazards-of-surgical-smoke.html. Accessed on May 28, 2020.
  25. “Control of Smoke From Laser/Electric Surgical Procedures (DHHS (NIOSH) Publication Number 96-128. ” (1996) Center for Disease Control and Prevention: The National Institute for Occupational Safety and Health (NIOSH). Available from: https://www.cdc.gov/niosh/docs/hazardcontrol/hc11.html.
  26. Brat, G. A., Hersey, S., Chhabra, K., Gupta, A., & Scott, J. (2020). Protecting Surgical Teams During the COVID-19 Outbreak: A Narrative Review and Clinical Considerations. Annals of Surgery, 1. https://doi.org/10.1097/SLA.0000000000003926
  27. Danielle Wajngarten and Patrícia Petromilli Nordi Sasso Garcia (2019). Effect of magnification devices on dental students’ visual acuity. PLoS
    One. 2019; 14(3): e0212793. 2019 March 27.
  28. “Operational Considerations for Personal Protective Equipment in the Context of Global Supply Shortages for Coronavirus Disease 2019 (COVID-19) Pandemic: non-US Healthcare Settings”. (2020) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/emergencyconsiderations-ppe.html. Accessed March 25, 2020
  29. “Short-Term Recommendations for Cutaneous Melanoma Management During COVID-19 Pandemic Version 3 (5/6/2020)”. (2020). National Comprehensive Cancer Network. Available at: https://www.nccn.org/covid-19/pdf/Melanoma.pdf. Accessed on March 25, 2020
  30. “Advisory Statement for Non-Melanoma Skin Cancer Care During the COVID-19 Pandemic (Version 4, May 22, 2020) (2020). National Comprehensive Cancer Network. Available at: https://www.nccn.org/covid-19/pdf/NCCN-NMSC.pdf. Accessed on May 30, 2020
  31. Dover JS, Moran ML, Figueroa JF, et al. A PATH TO RESUME AESTHETIC CARE EXECUTIVE SUMMARY OF PROJECT AesCert™ GUIDANCE SUPPLEMENT: PRACTICAL CONSIDERATIONS FOR AESTHETIC MEDICINE PROFESSIONALS SUPPORTING CLINIC PREPAREDNESS IN RESPONSE TO THE SARS-CoV-2 OUTBREAK [published online ahead of print, 2020 May 2]. Facial Plast Surg Aesthet Med. 2020;10.1089/abc.2020.0239.
    doi:10.1089/abc.2020.0239
  32. “COVID-19 Safe Cosmetic Injecting Guide 2020” (2020). Australasian Society of Aesthetic Plastic Surgeons and the Australasian Society of Cosmetic Dermatologists. Available at: https://aestheticplasticsurgeons.org.au/wp-content/uploads/2020/05/ASAPS-ASCD-COVID-SAFEINJECTING-
    GUIDE-2020-v7.pdf. Accessed on: May 30, 2020
  33. Gallo, O, Locatello, LG. Laser-assisted head and neck surgery in the COVID-19 pandemic: controversial evidence and precautions. Head & Neck. 2020; 1– 2. https://doi.org/10.1002/hed.26271
  34. Ilmarinen T, Auvinen E, Hiltunen-Back E, Ranki A, Aaltonen LM, Pitkäranta A. Transmission of human papillomavirus DNA from patient to surgical
    masks, gloves and oral mucosa of medical personnel during treatment of laryngeal papillomas and genital warts. Eur Arch Otorhinolaryngol.
    2012; 269(11): 2367- 2371. https://doi.org/10.1007/s00405-012-2049-9.
  35. Smalley PJ. Laser safety: risks, hazards, and control measures. Laser Ther. 2011; 20(2): 95- 106. https://dx.doi.org/10.5978%2Fislsm.20.95.
  36. Ravishankar A., Turetsky Y., Novotny S., Allen T., Farah R.S. Implementing laser safety standards in the outpatient Academic dermatology clinic: a
    quality improvement based study. Laser Surg. Med. 2019 doi: 10.1002/lsm.23174
  37. Sarnoff D., Gotkin H., Doerfler B., Gustafson J., Hanke C.W. The safety of laser skin resurfacing with the microablative carbon dioxide laser and review of the literature. J. Drugs Dermatol. JDD. 2018;17:1157–1162
  38. Bargman H. Laser safety guidelines. J. Clin. Aesthetic Dermatol. 2010;3:18–19.
  39. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020; 382: 1177- 1179.
    https://doi.org/10.1056/NEJMc2001737.
  40. Emadi SN, Abtahi-Naeini B. Coronavirus Disease 2019 (COVID-19) and dermatologists: Potential biological hazards of laser surgery in epidemic
    area [published online ahead of print, 2020 April 6]. Ecotoxicol Environ Saf. 2020;198:110598. doi:10.1016/j.ecoenv.2020.110598
  41. Lister T. Clinical guidelines for laser procedures during the COVID-19 pandemic. April 2020. https://www.bmla.co.uk/clinical-guidance-forlaser-procedures-during-the-covid-19-pandemic/
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Procedural dermatology in the COVID-19 era: an online survey of the Philippine Dermatological Society members and practical recommendations for safe practice