Αθήνα, Τρίτη 31 Μαρτίου 2020
ΑΝΑΚΟΙΝΩΣΗ
Dear colleagues,
Based on the recent guidelines of the European ENT and Rhinological Society, as well as the American Academy, Otolaryngologists, along with Intensivists and Anesthesiologists, are considered to be the healthcare professionals with the most exposure to COVID-19 and therefore with the greatest risk of spreading the disease. ENT may not be mentioned as the specialty that is on the front lines, but all epidemiological data from China, Iran, Italy, USA indicate that we belong to the high risk healthcare group. This is because we are exposed to a high viral load during diagnostic and therapeutic procedures in the upper airway. Therefore, we must be vigilant to protect ourselves on the one hand, but mainly to avoid spreading the disease on the other (e.g., a nose surgery in China infected 14 workers who were in the surgery).
Also, recent observations have shown that in 20-60% of patients with COVID-19, smell and/or taste disorders were precursor symptoms of the disease. Therefore, it should be emphasized that for the sake of early diagnosis, all patients should be asked about a possible recent smell or taste disorder and, in the event of a positive response, even without other symptoms, be considered initially positive, isolated and seek immediate further medical advice.
Proposed measures:
1. Routine examinations should be postponed and much of the medical care provided by telephone. All endoscopic examinations in our specialty should be avoided unless they are emergencies and when they are performed, all necessary precautions should be taken.
2. Avoid non-urgent surgeries, especially nose, paranasal, oropharynx, larynx, while tracheotomies should be performed in hospital operating rooms. In any case, reducing/avoiding exposure is the only effective measure for everyone, especially for middle-aged and elderly colleagues, as well as those with chronic health problems.
3. All ENT doctors should have the necessary protective equipment and meticulously follow personal protection instructions.
Specifically:
- Thorough hand washing before and after each procedure.
- Throughout your stay at the health center, it is recommended to wear a simple surgical mask and gloves. Avoid touching the mask with your hands.
- The N95 or FFP3 mask should theoretically be changed after each patient. Due to lack of resources, this is impossible to happen worldwide. However, it has been proven that due to colonization of the mask, using it for more than 8 hours is dangerous.
- Do not re-apply the surgical mask or N95 mask with your hands.
- Η τοποθέτηση του
προστατευτικού εξοπλισμού γίνεται με την εξής σειρά
- Πλύσιμο χεριών και εφαρμογή αντισηπτικού υγρού
- Κάλυψη τριχωτού κεφαλής
- Τοποθέτηση αδιάβροχης ποδιάς και μπλούζας
- Τοποθέτηση μάσκας Ν95/FFP3 και έλεγχος εφαρμογής
- Τοποθέτηση γυαλιών
- Τοποθέτηση 2 ζευγών γαντιών
- Ενδιάμεσα των σταδίων χρήση αντισηπτικού διαλείμματος
- Εξίσου σημαντική και η
διαδικασία αφαίρεσης του εξοπλισμού
- Αφαίρεση του ζεύγους γαντιών εργασίας αφού πρώτα εφαρμοστεί αντισηπτικό διάλειμμα
- Εκ νέου εφαρμογή αντισηπτικού και τοποθέτηση καθαρού ζεύγους γαντιών
- Αφαίρεση μπλούζας και γυαλιών χωρίς να ακουμπήσουν την πρόσθια επιφάνεια
- Αφαίρεση μάσκας χωρίς τα χέρια να αγγίξουν το φίλτρο
- Αφαίρεση κάλυψης τριχωτού κεφαλής
- Αφαίρεση γαντιών
- Εκ νέου επιμελές πλύσιμο χεριών
In any case where manipulations in the upper airway are required, the use of an apron and surgical mask (FFP3 or FFP2/N95), fluid-resistant gloves and protective glasses is recommended.
4. Patients should continue their treatment. Although there is limited evidence that systemic corticosteroids may increase ARDS in patients with SARS and MERS, there is no evidence to suggest that the use of topical corticosteroids will increase susceptibility to coronavirus. One could argue that stopping nasal corticosteroids in patients who need them will lead to more symptoms of allergic rhinitis/rhinosinusitis that may obscure the symptoms of COVID-19.
5. Patients who are going to undergo emergency procedures, if time is available, should be tested pre-operatively for COVID-19. It is considered necessary to use special protective equipment even if the result is negative (FFP3 or FFP2/N95 masks, special glasses, double gloves, disposable suits). In patients positive for COVID-19, the use of special equipment is necessary according to the EODY protocol.
Suggestions to the state:
1. Provision of the necessary protective equipment to ENT doctors (private and public sector) as frontline doctors and at high risk of infection and spread.
2. Pre-operative COVID-19 testing in all cases scheduled to undergo ENT procedures.
3. Reinforcement of ENT departments in hospitals with emergency medical and nursing staff, according to the capabilities and planning of the Ministry of Health, to avoid the risk of staff shortages in the event of mass exposure (e.g. University ENT Clinic of Hippocrates Hospital of Athens).
Dear colleagues,
In the critical circumstances we face, we must all demonstrate the required composure, as well as individual and social responsibility.
As the Panhellenic Society of Otolaryngology, Head and Neck Surgery, we will take all the necessary actions and actions to ensure the smooth functioning of all of us for the benefit of the Society and the State.
Suggested Bibliography:
1. European Rhinologic Society. http:/www.europeanrhinologicsociety.org.
2. IFOS http://www.yoifos.com/covid-19-information-and-guidance
3. COVID-19 information for health professionals www.entuk.org/covid-19
4. Handbook of Covid-19 from the First Affiliated Hospital, Zhejiang University School of Medicine http:/www.britishlaryngological.org/news/covid-19-important-guidance.
5. American Academy of Otolaryngology Head and Neck Surgery
6. Consensus statement: Safe Airway Society principles of airway management and
tracheal intubation specific to the COVID-19 adult patient group, Med J Aust 16
March 2020, David J Brewster, Nicholas C Chrimes, Thy BT Do, Kirstin Fraser,
Chris J Groombridge, Andy Higgs, et al. LINK.
7. Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-Mediated Inflammatory
Responses: From Mechanisms to Potential Therapeutic Tools. Virol Sin. 2020.
8. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et
al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a
Clinically Proven Protease Inhibitor. Cell. 2020.
9.Kruse RL. Therapeutic strategies in an outbreak scenario to treat the novel
coronavirus originating in Wuhan, China. F1000Res. 2020;9:72.
10.Lee N, Allen Chan KC, Hui DS, Ng EK, Wu A, Chiu RW, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol. 2004;31(4):304-9.
11.Stein RA. The 2019 coronavirus: Learning curves, lessons, and the weakest link. Int J Clin Pract. 2020;74(4):e13488.
12. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020.
