DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20203222

ENT endoscopic procedures and aerosolization during COVID-19 pandemic: a review of concepts and guidelines

Mukul Patar, Kusum Borsaikia, Taufeequl Islam

Abstract


Otolaryngologists are more prone for exposure to aerosols during routine ENT examination and endoscopic procedures. ENT endoscopy procedures are considered as most aerosol-generating procedures and preferably routine procedures are avoided and deferred, if at all not necessary or urgent at this time of COVID-19 pandemic. The small particle size and extended travel of airborne aerosols mandate the use of specific personal protective equipment (PPE) and barriers by the health care workers to protect against transmission of COVID-19. Studies have recommended ENT endoscopy in awake patients with adequate topical preparation for local anaesthesia. Use of sprays should be avoided, instead, carefully placed pledgets should be used to provide adequate decongestion and anesthesia. Well ventilated endoscopy room with negative pressure (preferably), wearing a N95 mask with face shield or full PPE, thorough cleaning of entire endoscope after removal by standard disinfectants, decontamination of endoscopy room after each procedure and proper disposal of contaminated waste products are some common guidelines advised by health authorities globally till date.


Keywords


COVID-19, ENT endoscopy, Aerosol

Full Text:

PDF

References


Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, surface, environmental and personal protective equipment contamination by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) from asymptomatic patient. JAMA 2020.

Cai J, Xu J, Lin D, Yang Z, Xu L, Qu Z, et al. A case series of children with 2019 novel Coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020.

Chang D, Mo G, Yuan X, Tao Y, Peng X, Wang F, et al. Time kinetics of viral clearance and resolution of symptoms in novel Coronavirus infection. Am J Respir Crit Care Med. 2020.

Sagardoyb LT, Akkaric M, Ayari-Khalfallahd S, Celeriera C, Fayoux P, Luscan R, Mansbach AL,et al. COVID-19 and ENT Pediatric otolaryngology during the COVID-19 pandemic. Guidelines of the French Association of Pediatric Otorhinolaryn-gology (AFOP) and French Society of Otorhino-laryngology (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(3):177-181.

Otolaryngologists and the COVID - 19 pandemic; American Academy of Otolaryngology - Head and Neck Surgery; 1650 Diagonal Rd, Alexandria,VA 22314; Available at: https://www.entnet.org. Accessed on 23 March 2020.

Fehr AR, Perlman S. Coronaviruses: An overview of their replication and pathogenesis. In: Coronaviruses: Methods and Protocols. 2015. US Centers for DiseasSe Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019 -ncov/infection-control/control-ecommendations. html. Accessed on 23 March 2020.

Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al. Endonasal Instrumentation and Aerosolization Risk in the Era of COVID-19: Simulation, Literature Review, and Proposed Mitigation Strategies. Int Forum Allergy Rhinol. 2020;10(7):798-805.

Booth TF, Kournikakis B, Bastien N, Ho J, Kobasa D, Stadnyk L, et al. Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units. J Infect Dis 2005;191:1472-7.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-7.

Seto WH. Airborne transmission and precautions: facts and myths. J Hosp Infect 2015;89:225-8.

Thompson KA, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic--the risk of aerosol generation during medical procedures. PLoS One. 2013;8:e56278.

Europe’s Doctors Repeat Errors Made in Wuhan, China Medics Say. Bloom News. 2020.

Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-9.

Merrett D, Knox E, Thach L, Beckett T, Burk B, Light A. FIO2 Capability of a Procedural Oxygen Mask During Different Breathing Patterns and Oxygen Flows. Respir Care. 2019;64:3239438.

Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, et al. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngology-Head Neck Surg. 2020.

Chun-hui L, Xun H, Meng C. Expert consensus on personal protection in different regional posts of medical institutions during novel coronavirus pneumonia(COVID-19) epidemic period. Chinese J Infection Control. 2020;19(3):1-15

Cui C, Yao Q, Zhang D, Zhao Y, Zhang K, Nisenbaum E, Cao P, et al. Approaching Otolaryngology Patients during the COVID-19 Pandemic. Otolaryngol Head Neck Surg. 2020:0194599820926144.

Training module on COVID-19 for the State of Assam, published on 07-05-2020 as per direction of Ministry of Health and Family Welfare, Govt of Assam, India. Available at: https://covid19.assam. gov.in. Accessed on 2 March 2020.

Kramer A, Kohnen W, Israel S, Ryll S, Hubner NO Luckhaupt H, et al. Principles of infection prevention and reprocessing in ENT endoscopy. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015.

Chiu PWY, Ng SC, Inoue H, Reddy DN, Ling Hu E. Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDECOVID statements). Gut. 2020.

Luca PD, Scarpa A, Ralli M, Vincentiis MD, Cassandro E, Chiarella G, et al. Nasal, pharyngeal and laryngeal endoscopy procedures during COVID‑19 pandemic: available recommendations from national and international societies. European Archives of Oto-Rhino-Laryngology. 2020.

ENTUK-The Royal College of Surgeons of England Nasal endoscopy and laryngoscopy examination of ENT patients. 2020. Available at: https://www. entuk.org/sites/default/files/Nasal%20endoscopy%20and%20laryngoscopy%20examination%20of%20ENT%20patients_compressed%20%281%29.pdf. Accessed on 2 March 2020.