Abstract
Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard “Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016),” we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.
中文概要
目的
在疫情期间, 需要通过保证内镜处理质量, 避免 过程环节操作中的接触污染, 防止气溶胶的散 发, 从而保护从业人员, 杜绝院内感染。
创新点
内镜诊疗对改善重症患者预后及降低患者死亡率 有重要作用。该研究依据实际临床工作特质, 对 内镜再处理过程中的部分方法及化学清洗消毒 剂的选择进行了改良与替换。
方法
从12 例重症患者行23 次内镜诊治后的内镜处理 操作中提取经验, 结合相关指南规范, 提出了新 型冠状病毒肺炎患者床边内镜诊疗后内镜再处 理改良流程。
结论
内镜诊疗在重症及危重症患者治疗中不可或缺。 临床工作中床旁预处理操作及专线转运流程对 于预防院内感染具有重要意义。替换后的化学清 洗消毒剂(0.23%过氧乙酸)对新冠病毒可达到 高水平消毒。改良后的床边内镜诊疗后内镜再处 理操作流程顺畅, 感染控制严谨, 值得临床进一步推广。
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References
AQSIQ (General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China), 2012. Hygienic Standard for Disinfection in Hospitals, GB 15982-2012. National Standards of People’s Republic of China (in Chinese).
Bakanidze L, Imnadze P, Perkins D, 2010. Biosafety and biosecurity as essential pillars of international health security and cross-cutting elements of biological nonproliferation. BMC Public Health, 10(Suppl 1):S12. https://doi.org/10.1186/1471-2458-10-S1-S12
CSDE (Chinese Society of Digestive Endoscopology), 2020a. Guiding principles on gastrointestinal endoscopic diagnosis and treatment during the prevention and control of COVID-19 by the Chinese Society of Digestive Endoscopology. http://www.csde.org.cn/news/detail.aspx?article_id=2883 [Accessed on Apr. 3, 2020] (in Chinese).
CSDE, 2020b. Recommendations for endoscope cleaning, disinfection and sterilization in gastrointestinal endoscopy center during the prevention and control of COVID-19 by the Chinese Society of Digestive Endoscopology. http://www.csde.org.cn/news/detail.aspx?article_id=2884 [Accessed on Apr. 3, 2020] (in Chinese).
Emergency Care Research Institute, 2018. Top 10 Health Technology Hazards for 2019. https://www.ecri.org/Resources/Whitepapers_and_reports/Haz_19.pdf [Accessed on Apr. 3, 2020].
Fang Y, 2011. Practical Endoscopic Cleaning and Disinfection Techniques. Zhejiang University Press, Hangzhou, China (in Chinese).
Gu Q, Xu M, Sheng TT, et al., 2018. The cleaning effect of peroxyacetic acid sterilizing powder on organics on endoscopes. Nurs Rehabil J, 17(2):69–70 (in Chinese).
Gu Q, Lin YM, Cen L, et al., 2019. Endoscopic ultrasonography is useful in the diagnosis and treatment of rectal neuroendocrine neoplasms: a case series. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(10):861–864. https://doi.org/10.1631/jzus.B1900168
Huang CL, Wang YM, Li XW, et al., 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395(10223):497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
Lou SM, Zhang M, Wu ZR, et al., 2019. Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(11):940–944. https://doi.org/10.1631/jzus.B1900060
NHC (National Health Commission of the People’s Republic of China), 2020a. Guideline for diagnosis and treatment of COVID-19 (the sixth trial version). http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml [Accessed on Apr. 3, 2020] (in Chinese).
NHC, 2020b. Guidelines for the prevention and control of COVID-19 in health care facilities (the first version). http://www.nhc.gov.cn/yzygj/s7659/202001/b91fdab7c304431eb082d67847d27e14.shtml [Accessed on Apr. 3, 2020] (in Chinese).
NHFPC (National Health and Family Planning Commission of the People’s Republic of China), 2017a. Regulation for Cleaning and Disinfection Technique of Flexible Endoscope, WS 507-2016. National Standards of People’s Republic of China (in Chinese).
NHFPC, 2017b. Regulation for Prevention and Control of Healthcare Associated Infection of Airborne Transmission Disease in Healthcare Facilities, WS/T 511-2016. National Standards of People’s Republic of China (in Chinese).
WHO (World Health Organization), 2020. Clinical management of severe acute respiratory infection when COVID-19 is suspected. Interim guidance. https://www.who.int/publications-detail/clinical-management-of-severe-acutere-spiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected [Accessed on Apr. 3, 2020].
Wu JT, Leung K, Leung GM, 2020. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet, 395(10225):689–697. https://doi.org/10.1016/S0140-6736(20)30260-9
Xia TT, Shi S, Yang JY, et al., 2019. The latest developments of flexible endoscopes reprocessing in China and other countries. Chin J Nosocomiol, 29(8):1272–1277 (in Chinese).
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Conceived and designed the study: Qing GU, Hua-fen WANG, and Zhe SHEN. Collected the data: Qing GU, Ying FANG, Zhe SHEN, Yan WANG, and Xin WU. Analyzed the data: Qing GU, Ying FANG, Ye LU, Zhe SHEN, Yan WANG, Xin WU, and Li CEN. Wrote the paper: Qing GU, Hua-fen WANG, Ying FANG, Ye LU, Zhe SHEN, Yan WANG, Xin WU, Li CEN, and Yi-shu CHEN. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Qing GU, Hua-fen WANG, Ying FANG, Ye LU, Zhe SHEN, Yan WANG, Xin WU, Li CEN, and Yi-shu CHEN declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for whom identifying information is included in this article.
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Analysis of an improved workflow of endoscope reprocessing for bedside endoscopic diagnosis and treatment on COVID-19 patients
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Gu, Q., Wang, Hf., Fang, Y. et al. Analysis of an improved workflow of endoscope reprocessing for bedside endoscopic diagnosis and treatment on COVID-19 patients. J. Zhejiang Univ. Sci. B 21, 416–422 (2020). https://doi.org/10.1631/jzus.B2000109
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DOI: https://doi.org/10.1631/jzus.B2000109
Key words
- Novel coronavirus
- Coronavirus disease 2019 (COVID-19)
- 2019 novel coronavirus (2019-nCoV)
- Disinfection
- Gastrointestinal endoscopy
- Infection prevention and control