Performing endoscopic exams puts staff at risk of contracting infections like COVID-19 due to the body fluids or aerosolized droplets they come into contact with from the patient.
Researchers from the gastroenterology departments of the Tohoku University Graduate School of Medicine and the Japan Community Health Care Organization's Sendai Hospital realized this was a problem and have developed a new device to provide additional protection for healthcare workers performing esophagogastroduodenoscopies.
"Under the current pandemic situation of COVID-19, medical staff in endoscopy units face a risk of SARS-Cov-2 infection derived from direct contact with body fluids or aerosol droplets via coughing and retching by the subjects," Dr. Hiroyuki Endo, medical director of the department of gastroenterology at Japan Community Health Care Organization Sendai Hospital and corresponding author of the paper, told HCB News. "Although indications and protective procedures for gastrointestinal endoscopy have recently been enhanced, little has been reported on preventing the diffusion of aerosol droplets from subjects. In terms of standard precaution, a simple and inexpensive device is needed for every endoscopy."
The inexpensive solution is composed of a mouthpiece that comes equipped with a fixing belt and a square, non-woven fabric attached to the top of the mouthpiece. The fabric covers the patient’s face and has an X-shaped incision at the center that acts as a sleeve for the endoscope. This provides minimal interference and captures aerosol droplets derived from the coughing and retching of the patient. The non-woven fabric supported by the mouthpiece is expected to capture the coarse droplets and to reduce the diffusion of aerosol droplets to some extent because it can cover the mouth and nose of the subject.
The solution can be used whether the doctor is examining a patient’s esophagus, stomach or upper intestines. The fabric maintains high elasticity and air permeability, providing the patient with minimal discomfort, and does not create a tight enclosure, which would expose patients to respiratory stress and risk choking if vomiting.
In addition to protecting workers when using devices like endoscopes, providers also must implement tactics and regulations around appropriate disinfection of equipment to further mitigate risk. The National Electrical Manufacturers Association recently published guidelines for maintaining cleanliness
, while still preserving the functionality and integrity of equipment.
“The first consideration is worker safety, so following documented safety procedures is essential,” said Kevin J. Cosgriff, president and CEO of NEMA, in a statement. “Electrical Safety Foundation International is a good source for general safety information. Beyond that, all cleaning and disinfecting steps must bear in mind the need to protect electrical equipment from inappropriate cleaning and disinfecting products and methods. In most cases, the original equipment manufacturer is the best source of authoritative information regarding products made by them.”
Endo says there have been reports of other devices designed to prevent the diffusion of aerosol droplets during endoscopic procedures. Many consist of a cube or box which covers the head of the subjects. While effective, especially in emergent exams for SARS-Cov-2 infected patient, many are difficult to use as regular tools in endoscopy and can limit the full potential of procedures.
"It would be difficult to utilize these devices as standard precaution for every endoscopy," said Endo. "Furthermore, the endoscopic procedure under these devices would be restricted to some extent. In contrast, our disposable device is so simple and inexpensive. Since this nonwoven fabric has appropriate elasticity, the operation stress for the endoscopist would be within acceptable level."
The device has not been named as of yet.