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1.
Clinics (Sao Paulo) ; 75: e1989, 2020.
Article in English | MEDLINE | ID: covidwho-608407

ABSTRACT

OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Endoscopy/standards , Hospitals, University/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Brazil , Coronavirus Infections/transmission , Endoscopy/methods , Health Personnel/standards , Humans , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Risk Factors
3.
Rhinology ; 58(3): 289-294, 2020 Jun 01.
Article in English | MEDLINE | ID: covidwho-342762

ABSTRACT

On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Endoscopy , Nose Diseases , Pandemics , Personal Protective Equipment , Pneumonia, Viral , Skull Base , Coronavirus Infections/epidemiology , Endoscopy/methods , Humans , Infection Control , Nose Diseases/surgery , Pneumonia, Viral/epidemiology , Skull Base/surgery
5.
Otolaryngol Head Neck Surg ; 163(1): 145-150, 2020 07.
Article in English | MEDLINE | ID: covidwho-306336

ABSTRACT

OBJECTIVE: The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures. STUDY DESIGN: Cadaver simulation series. SETTING: Dedicated surgical laboratory. SUBJECTS AND METHODS: After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition. RESULTS: There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm). CONCLUSION: Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Disease Transmission, Infectious/prevention & control , Endoscopy/methods , Nose Diseases/surgery , Pneumonia, Viral/complications , Rhinoplasty/methods , Simulation Training/methods , Cadaver , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Nose Diseases/complications , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Treatment Outcome
6.
Int J Pediatr Otorhinolaryngol ; 135: 110092, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-197689

ABSTRACT

While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, raising concern about risk to healthcare workers during aerosol generating procedures (APGs) in the airway and nasopharynx. Herein we describe the first case of a nasal foreign body in an asymptomatic child with SARS-CoV-2 infection. We discuss management of this child and highlight the importance of considering asymptomatic infection and preoperative testing when planning procedures of the airway in the COVID-19 era.


Subject(s)
Asymptomatic Infections , Betacoronavirus/isolation & purification , Coronavirus Infections , Endoscopy/methods , Foreign Bodies/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Nose/virology , Pandemics , Pneumonia, Viral , Betacoronavirus/genetics , Child, Preschool , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Female , Humans , Nose/surgery , Pneumonia, Viral/diagnosis , Preoperative Care , Reverse Transcriptase Polymerase Chain Reaction
7.
Dig Liver Dis ; 52(6): 606-612, 2020 06.
Article in English | MEDLINE | ID: covidwho-125330

ABSTRACT

A dramatic SARS-Cov-2 outbreak is hitting Italy hard. To face the new scenario all the hospitals have been re-organised in order to reduce all the outpatient services and to devote almost all their personnel and resources to the management of Covid-19 patients. As a matter of fact, all the services have undergone a deep re-organization guided by: the necessity to reduce exams, to create an environment that helps reduce the virus spread, and to preserve the medical personnel from infection. In these days a re-organization of the endoscopic unit, sited in a high-incidence area, has been adopted, with changes to logistics, work organization and patients selection. With the present manuscript, we want to support gastroenterologists and endoscopists in the organization of a "new" endoscopy unit that responds to the "new" scenario, while remaining fully aware that resources, availability and local circumstances may extremely vary from unit to unit.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Endoscopy/methods , Gastrointestinal Diseases , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/trends , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Risk Adjustment/methods , Risk Adjustment/organization & administration
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