- Health-care workers and other patients in ENT departments are especially at high risk of contracting the Covid-19, since most of the procedures involve direct contact with patients’ upper respiratory tract mucosa and can potentially induce patients to sneeze or cough.
- Nose and throat examinations have the highest risk of contamination and transmission among ENT examinations, thus additional preventive measures should be implemented:
- During flexible laryngoscope examination, gel anaesthesia is preferred over local anaesthetic spray to reduce irrigated nausea and cough, and the smallest diameter laryngoscope was recommended.
- During nasal endoscopy, an adequate surface anaesthesia should be obtained in order to reduce the sneeze reflex.
- With substantial presymptomatic carriers of the virus, PPE precautionary practices are required: N95 respirator, gown, cap, eye protection, and gloves
- For aerosol-generating procedures: Before tracheal nursing procedures, suction should be used to minimize sputum production and generation of aerosol. The use of closed suction is preferred over open-type suction for patients with tracheostomy.
- The flowchart guiding the decision-making process for the management of ENT emergency patients can be summarized in the decision-tree available here.
These statements come from the experts’ opinions from chinese hospitals published in the Journal of Hospital Infection and JAMA Otolaryngology and Head Neck Surgery. The recommendations are based on the previous experiences from SARS and the current COVID-19 outbreak in the different regions of China.
- Lu D, Wang H, Yu R, Yang H, Zhao Y. (February 27, 2020). Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. https://doi.org/10.1016/j.jhin.2020.02.018
- Chan JYK, Wong EWY, Lam W. (March 20, 2020). Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2020.0488
- Recommended personal protective equipment (PPE) in hospitals/clinics under serious/ emergency response level (February 8, 2020). Centre for Health Protection. https://www.chp.gov.hk/files/pdf/recommended_ppe_for_ nid_eng.pdf