Guideline for ENDOSCOPY CENTRES in COVID 19 epidemic
GUIDELINES FOR THE ENDOSCOPY CENTRES FOR THE PROTECTION OF PATIENTS / STAFF FROM POTENTIAL RISK OF COVID 19 INFECTION
Author – Prof Mohan de Silva
Endoscopy centres face significant risk for diffusion of respiratory diseases that can be spread via an airborne route during aspiration of oral and fecal material via endoscopes. Virus transmission can occur during the incubation period in asymptomatic patients undergoing upper and lower GI endoscopic procedures
Following measures must be implemented and maintained to protect both patients and personnel to avoid unrecognized endoscopy-related diffusion and spread of the virus
Only the patient and if needed, one accompanied person is allowed to enter the Endoscopy Centre
Check the temperature of the patient (Definition of fever >37.5C)
Then
Stratify the risk of COVID – 19 using the following questions
In the last 14 days have you had fever (>37.5°C), cough, sore throat, or respiratory problems?
Have you had family or close contact with a suspicious or confirmed case of COVID-19?
Did you come from abroad with in last 14 days?
If the answer to one or more of these questions is positive, it is strongly advised to defer the procedure unless the procedure is performed to save life or for an immediately life-threatening condition
All patients entering the endoscopy unit must wear a surgical mask
Mask has to be removed just before commencing the procedure if the procedure involves Upper GI tract
Mask has to be replaced again once the patient has recovered from sedation sufficiently to maintain oxygen saturation above 90% on room air
All staff must wear face masks, gloves and head cover during work in the unit
All staff directly handling the endoscopes must wear disposable protective gowns in addition to surgical mask, gloves and head cover
Staff should wear 2 pairs of gloves, one inner pair of gloves covering the skin up to the wrist and one outer pair of gloves, the real “working gloves”
All patient interactions by staff before the procedure (consent signature, patient instructions for the procedure), during (assisting) and after (vital signs recording) must be done with a reasonable distance from every patient
It is mandatory for all staff to wash hands with soap and water or alcohol-based hand scrub before and after each procedure
At the end of the examination, the removal of the personal protective equipment is a crucial part of the procedure
Gloves are removed first because they are now considered heavily contaminated and a new pair of disposable glows is worn immediately
Next is the head cover followed by the gown
Last to be removed is the latest pair of gloves
After gloves removal, hand hygiene should be repeated with soap and water or alcohol solution
Disinfection of endoscopes and accessories should be done with a uniform, standardized reprocessing procedure
Decontamination policy for endoscopy roomat the end of the daily procedures
Cleaning process should include cleaning of all surfaces using 1:100 dilution of household bleach and water as SARS coronavirus is known to be stable in feces and urine for at least 1 to 2 days; thus, surfaces might be a possible source of contamination