Douglas G. Adler, MD, FACG, AGAF, FASGE reviewing Soetikno R et al.
Gastrointest Endosc 2020 Mar 27
Many new practices need to be implemented to protect endoscopists, staff, and patients during the pandemic.
- All gastrointestinal (GI) procedures should be triaged by trained personnel and rescheduled if not time-sensitive. This includes most screening and surveillance colonoscopies.
- Healthcare workers performing upper or lower GI procedures:
- Should use the N95 mask, regardless of a patient’s COVID-19 status. Alternatives are the N99 mask and powered air-purifying respirators.
- Should notuse surgical masks as a substitute for N95 masks during GI procedures in patients with confirmed or presumed COVID-19.
- In resource-limited settings, reuse of the N95 mask is preferred to surgical mask use during GI procedures.
- Should double-glove (i.e., one pair under the gown sleeve and another above it) during procedures regardless of a patient’s COVID-19 status.
- If available, negative-pressure rooms are preferred.
- Standard endoscope reprocessing and disinfection are effective and do not need to be altered.
- Providers should practice and be observed practicing donning and doffing of personal protective equipment (PPE). These maneuvers are detailed on the CDC website.
Globally, hospitals and clinics are grappling with the new reality of practicing medicine during the COVID-19 pandemic. Endoscopy labs, which perform a wide range of aerosol-generating procedures, have been the focus of significant attention. In a new report, endoscopists from the U.S., Hong Kong, and other countries share practical suggestions for reducing COVID-19 transmission risk, based on the literature and their own experience.
Their key points and recommendations include the following:
- All endoscopic procedures are aerosol generating.
- All surfaces in the procedure room can potentially become contaminated and need appropriate disinfection.
- Ensure performance of fit testing for N95 masks or other appropriate personal protective equipment (PPE).
- Practice proper hand hygiene.
- Set up a reception bay to screen and stratify patients by their risk for COVID-19 infection before allowing them to even enter the waiting area.
- Test all suspected infected patients before the procedure.
- Use a dedicated procedure and recovery room for COVID-19 patients and wear appropriate PPE.
- Don and doff PPE in a designated area.
- Have staff take their own temperature daily to rule out unsuspected fevers.
- Limit the number of healthcare providers participating in any procedure to only those absolutely necessary.
- For procedures under general anesthesia, only the anesthesiologist and key assistants should be present during intubation.