AGA issues COVID-19 recommendations for PPE use during GI procedures
The American Gastroenterologists Association released COVID-19 recommendations for personal protective equipment use during gastrointestinal procedures.
The recommendations, which were published in Gastroenterology, were approved by the AGA Institute Clinical Guidelines Committee, AGA Institute Clinical Practice Updates Committee and the AGA Governing Board.
All patients should be treated as though they have COVID-19 due to the lack of testing for the infection, the guidelines instruct.
“Acknowledging the resource constraints in most health systems, the panel also examined the role of extended use and re-use of respirators, such as N95s,” Shahnaz Sultan, MD, MHSc, AGAF, chair of the American Gastroenterological Association Clinical Guidelines Committee, told Healio Gastroenterology and Liver Disease. “We found limited data from the SARS epidemic demonstrating that up to 40% of health care professionals reported using their respirator for an extended time (one N95 for an 8-hour shift) but no information on whether the masks were just as effective in protecting health care professionals when used for extended time vs. one-time use.”
She added, “We relied on indirect evidence to help us in developing these recommendations, specifically data on the viability of SARS-CoV2 as an aerosolized pathogen for up to 3 hours and the inability of surgical masks to protect against aerosolized pathogens. Indirect evidence from the SARS also showed that health care professionals that were exposed or involved with tracheal intubations had 6.6 higher odds of developing infection likely from aerosolization of the virus.”
Recommendations for mask and glove use and triaging GI procedures include:
- All health care workers should wear N95 (or N99 or PAPR) masks for upper and lower GI procedures regardless of a patient’s presumed COVID-19 status. AGA recommends against surgical masks only for upper GI procedures, in known or presumptive COVID-19 patients.
- Double gloves should be used compared with single gloves for any GI procedure, regardless of a patient’s COVID-19 status.
- Negative pressure rooms should be used if available vs. a regular endoscopy room for any GI procedure in known or presumptive COVID-19 patients.
- Continuation of standard cleaning endoscopic disinfection and reprocessing protocols regardless of COVID-19 status.
- As a framework for triaging procedures, procedures should be reviewed by trained medical personnel and categorized as either time-sensitive or not time-sensitive.
- In an open access endoscopy system where indication may provide enough information to determine the time-sensitive nature of the procedure, consideration should be given for a telephone consultation with a referring provider, a telehealth visit or a multidisciplinary team approach to make a decision for complicated patients.
“Despite the limited direct evidence from COVID-19, we used the ‘best available evidence’ we could find to inform these recommendations highlighting where there was limited or scarce evidence,” Sultan said. – by Monica Jaramillo
References:
Sultan S, et al. Gastroenterology. 2020; doi: 10.1053/j.gastro.2020.03.072.
Disclosure: Sultan reports no relevant financial disclosures.