Professor Recipi is a gastrointestinal endoscopy expert from Milan, Italy. In the center of the hardest hit areas in Europe and even the world, their team not only fought the epidemic, but also reminded endoscopy units to be more careful to protect themselves and patients. Since Taiwan Province Province began to operate very early, I believe that many endoscopic units have established preliminary epidemic prevention contingency; But for this epidemic, there is no end in sight, and the expert's suggestion should bring more inspiration and help to everyone in epidemic prevention.
The original text was published in Gastrointestinal Endoscopy on March 65438, 2003. I just translated and summarized it. The original link is here. You can reprint, consult or supplement my articles yourself, hoping to help more people.
order
At present, the symptoms of COVID-19 are known to include fever, cough, weakness and diarrhea; About half of the patients will have dyspnea or even symptoms of ARDS, and the overall mortality rate is as high as 3.5%. (According to: As mentioned in the original text, Italy's current statistics are close to 10%, which may be related to the medical collapse)
The infection in COVID-19 is mainly droplets, and the direct distance between people mostly occurs within one meter (press: droplets are not included in objects, but spread by touch). Endoscopic units do not treat suspected patients in the first line like emergency or outpatient departments; However, there is evidence that during endoscopic examination, the secretions of the examinee will splash on the examinee's face without the examiner's knowledge. Are you online? In the study of SARS, the splashing distance can reach 10 meter (6 feet). In addition, such risks are not limited to gastroscopy, but may also occur in enteroscopy.
Because COVID-19 has a certain incubation period (the median is 5.5 days, which can be as high as 14 days or longer), travel history and contact history are very important clues to assess the risk of infection. Patients with the following characteristics should consider the possibility of COVID-19:
? Clinical symptoms: fever, cough, upper respiratory infection, pneumonia.
? Close contact history: lived together, had face-to-face contact (regardless of time), and lived in the same room (within two meters)
? Travel history of high-risk countries 14 days (according to Italy, Iran, and almost all Asian countries, Europe and America should also be included in the domestic situation)
Evaluation suggestions of subjects
? The day before the examination: telephone interview with customers to ask about symptoms, and if there are related symptoms, arrange an extension or cancellation.
? On the day of examination: ask again before examination, do you have the above clinical symptoms? /kloc-Do you have a travel history in high-risk areas within 0/4 days? Any history of close contact?
? If the customer is referred to another hospital, it is recommended to confirm the above information with other hospitals at present.
? Before the examination, arrange to take the temperature. If it is higher than 37 degrees, consider delaying the inspection.
? (Press: Generally, the definition of fever is above 37.5 degrees, but in COVID-19, many people have mild fever. Considering the error of thermometer, the standard should be judged by each unit and hospital. )
? Family members and nursing staff should be prohibited from entering the endoscope room at the same time.
? After the examination, contact the candidates who completed the examination in 7- 14 days, and follow up whether there are related symptoms (COVID-19).
According to the above information, we can divide the subjects into different risk groups, so as to evaluate the inspection procedure of endoscope and the protective preparation that should be carried out. Hereinafter, the personal protective equipment (PPE) of endoscopists mainly includes gloves, goggles, protective clothing and respiratory protection devices.
In personal protective equipment, masks are the most important, including medical masks or surgical masks, N95 masks. The former can effectively block water droplets, but it has no isolation effect on fine particles in the air; N95 can even isolate these small particles. In any case, the most important thing to wear a mask is to completely cover the nose and mouth, especially N95, and the edge of the mask needs to be completely close to the face to play a protective role. At present, doctors and nurses are advised to wear masks all the time in hospitals or clinics.
Patients should also be required to wear masks (preferably medical or surgical masks) throughout the hospital. Gloves are even recommended for the above-mentioned high-risk patients. If the client takes off the mask after the examination, he can't wear it for a period of time (such as after awakening from anesthesia). If possible, he can ask the client to wear a new mask after waking up.
Endoscope personnel protection
All endoscopists should follow the unit's standard protection guidelines. Whether it is inspectors, technicians or even people at the window/counter, they should keep a proper distance from the public in the process of confirming consent, measuring vital signs and preparing, and wash their hands before and after preparing and when contacting the subjects. In addition, wash your hands thoroughly before and after wearing protective gear and after touching any place that may contain infectious substances.
According to the above risks of subjects, the basic requirements for standard protection of endoscopists are as follows:
? Low risk: medical or surgical masks, hair caps, goggles, isolation gown, gloves (covering wrists).
? Moderate risk: If gastroscopy is considered as high risk, standard protection can be done if colonoscopy is done.
? High risk: N95 mask, hair cap, goggles, waterproof isolation gown, double gloves (covering wrists).
It is particularly emphasized that even in the case of shortage of epidemic prevention materials, abandoned equipment should not be reused as much as possible to avoid ineffective protection.
Wear sequence of protective equipment (important)
? Make sure there is no damage before wearing it.
? The first thing to put on is the hair cap.
? Next, isolation gown, then masks and goggles.
? Finally, wear gloves. When wearing double gloves, the inner layer should be surgical gloves that can wrap the wrist, and the outer layer should wear general medical gloves.
Disassembly sequence of protective equipment
? (Dry your hands with gloves) Take off your gloves.
? Wash your hands and put on new gloves (! )
? Put on new gloves and take off isolation gown, goggles, face mask and hair cap in turn.
? When taking off isolation gown, if it is a strap type, please ask your colleagues for assistance.
? When taking off goggles and masks, be careful not to touch the front (most secretions).
? Take off your new gloves.
? (Press: The quantity of gloves suggested above is very large, so it may be necessary to consider the adjustment of unit materials. Washing hands frequently is still the top priority! )
Is it necessary to check the negative pressure room?
If high-risk patients must be examined, it is best to do it in the negative pressure examination room, or in the negative pressure ward outside the unit if conditions permit.
Cleaning process of endoscope and accessories
It is recommended to follow the current standard procedures. According to the current international standard cleaning process, it is difficult for the virus to survive to an infectious level.
Cleaning procedure of endoscopy room (important)
Because the secretion of the subject will spread in the space and attach to the surface of the object, it is extremely important to disinfect the endoscope room in addition to personal protective equipment and frequent hand washing.
? Current data show that the virus can survive in feces for 1-2 days. Another updated paper (published after this suggestion) points out that COVID-19 can survive in air for 3 hours, on paper for 24 hours and on stainless steel and plastic for 72 hours. Therefore, environmental disinfection is extremely important.
? The most important point of disinfection is the parts that the hands often contact, the places that may contact secretions, that is, the examination bed (including the handle and edge), the floor, the instruments, the indoor tables and chairs (originally endoscopic furniture) and so on.
? The disinfectant recommended in this paper is 1: 100 diluted bleach (high concentration alcohol is also a reasonable option).
? If you are in the negative pressure ward, it is recommended to have the next examination after 30 minutes.
? If there is no negative pressure ward, it is necessary to carry out relatively high-risk inspection. It is recommended to evaluate whether to use air conditioning for ventilation and clean the room for one hour after inspection.
conclusion
"This is a difficult time for the whole world. As endoscopists, we have an additional responsibility to protect patients and ourselves. In the next few months, it is extremely important to strengthen and maintain infection control, including clearly defined procedures and close review and evaluation. Personal efforts and commitment to sensory control are like a handful of sand, but together they can build a solid and powerful barrier against deadly viruses. "
"For the whole world, this is a challenging time. As endoscopists and doctors, we have an additional responsibility to protect our patients and ourselves. In the next few months, it is really important to implement and strictly maintain these infection control measures through written agreements and special meetings. Everyone's level of commitment and personal efforts in preventing the spread of infection are like small grains of sand, which together help to build a solid and lasting barrier against this deadly virus. " ?
Italian, Taiwan Province province, the world, come on!