THE COMPARISON OF AEROSOL EXPOSURES TO ENDOSCOPY PERSONNEL PERFORMING UPPER GASTROINTESTINAL ENDOSCOPY IN THE PATIENTS WITH AND WITHOUT HEAD BOX MEASURED FROM DIFFERENT DISTANCES TO THE PATIENT'S MOUTH: A RANDOMIZED CONTROL TRIAL

ABSTRACT

DDW 2022 Author Disclosures Jukkaphop Chaikajornwat NO financial relationship with a commercial interest ;Rapat Pittayanon NO financial relationship with a commercial interest ;Prooksa Anancheunsook NO financial relationship with a commercial interest ;Rungsun Rerknimitr NO financial relationship with a commercial interest Introduction: Esophagogastroduodenoscopy (EGD) has been considered as an aerosol-generating procedures (AGP) with high risk of transmission of respiratory aerosols similar to an endotracheal intubation during COVID-19 pandemic. However, the risk of AGP at different distances to the patient’s mouth and the benefit of the protective measure such as the head box have never been fully studied. We performed a randomized control trial to evaluate the efficacy of acrylic head box for preventing the aerosol spreading to personnel standing at different distances to the patient’s mouth during EGD. Method: This trial is a randomized, open-label, single center, in adult patients scheduled for EGD between September and November 2021. Patients were randomly assigned with 11 allocation to either head box group or without head box group (control group). The 0.3- and 0.5-micron aerosol particles were measured with particle counters (PCE-PCO 1;PCE Deutschland GmbH, Meschede, Germany) at nurse anesthetist’s and endoscopist’s position for 2 minutes before EGD, and every 30 seconds automatically entire the procedure. The primary composite outcomes were the mean difference of aerosol particle level between during and before EGD at the nurse anesthetist’s face position (40 cm from the patient’s mouth) and at the endoscopist’s face position. (Figure) Result: The analysis included 50 patients undergoing EGD in each arm. The baseline characteristics were not difference between the 2 groups. The mean distance between the endoscopist’s face and the patient’s mouth was 66.1 ± 4.9 cm. (Figure) The mean differences of both 0.3- and 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the nurse anesthetist's position decreased in the head box group whereas those particle level increased in the control group (-491.9 versus 1095.8 particle/L (P=0.008) and -366.7 versus 249.8 particle/L (P=0.004), respectively). There was no significant difference of the mean differences of either 0.3- or 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the endoscopist’s position whether with or without headbox. (Table) Conclusion: EGD with the head box can reduce significant aerosolization to the endoscopy personnel including nurse anesthetist who standing near the patient’s mouth. However, those who stand further away such as the endoscopist who stands about 2 feet away from the patient’s mouth is already safe from aerosolization and does not get benefit from the head box because AGP from EGD affects only to the short-distant area. [Formula presented] [Formula presented]