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Risk of disease transmission from flexible nasoendoscopy during the coronavirus disease 2019 pandemic

Part of: JLO Coronavirus Collection

Published online by Cambridge University Press:  24 February 2021

F G Kavanagh Open the ORCID record for F G Kavanagh [Opens in a new window] ,
C Connolly ,
E Farrell ,
D Callanan ,
D Brinkman ,
A Affendi ,
E Lang  and
P Sheahan
F G Kavanagh*
Affiliation:
Institute of Research, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
C Connolly
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
E Farrell
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
D Callanan
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
D Brinkman
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
A Affendi
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
E Lang
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
P Sheahan
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland Ear, Nose, Throat and Oral (‘ENTO’) Research Unit, College of Medicine and Health, University College Cork, Cork, Republic of Ireland Department of Surgery, University College Cork, Republic of Ireland.
*
Author for correspondence: Dr Fergal Kavanagh, Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland E-mail: [email protected] Fax: +353 (21) 431 9794
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Abstract

Background

Concerns have emerged regarding infection transmission during flexible nasoendoscopy.

Methods

Information was gathered prospectively on flexible nasoendoscopy procedures performed between March and June 2020. Patients and healthcare workers were followed up to assess for coronavirus disease 2019 development. One-sided 97.5 per cent Poisson confidence intervals were calculated for upper limits of risk where zero events were observed.

Results

A total of 286 patients were recruited. The most common indication for flexible nasoendoscopy was investigation of ‘red flag’ symptoms (67 per cent). Forty-seven patients (16 per cent, 95 per cent confidence interval = 13–21 per cent) had suspicious findings on flexible nasoendoscopy requiring further investigation. Twenty patients (7.1 per cent, 95 per cent confidence interval = 4.4–11 per cent) had new cancer diagnoses. Zero coronavirus disease 2019 infections were recorded in the 273 patients. No. 27 endoscopists (the doctors and nurses who carried out the procedures) were followed up.The risk of developing coronavirus disease 2019 after flexible nasoendoscopy was determined to be 0–1.3 per cent.

Conclusion

The risk of coronavirus disease 2019 transmission associated with performing flexible nasoendoscopy in asymptomatic patients, while using appropriate personal protective equipment, is very low. Additional data are required to confirm these findings in the setting of further disease surges.

Keywords

COVID-19Flexible NasoendoscopyLaryngologyPatient Safety
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 3 , March 2021 , pp. 246 - 249
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr F Kavanagh takes responsibility for the integrity of the content of the paper

Presented orally at the Irish Otolaryngology Society Meeting, 10 October 2020, online.

References

Zhu, W, Huang, X, Zhao, H, Jiang, X. A COVID-19 patient who underwent endonasal endoscopic pituitary adenoma resection: a case report. Neurosurgery 2020;87:E140–6CrossRefGoogle ScholarPubMed
Chan, JYK, Wong, EWY, Lam, W. Practical aspects of otolaryngologic clinical services during the 2019 novel coronavirus epidemic: an experience in Hong Kong. JAMA Otolaryngol Head Neck Surg 2020;146:519–20CrossRefGoogle ScholarPubMed
Zou, L, Ruan, F, Huang, M, Liang, L, Huang, H, Hong, Z et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177–9CrossRefGoogle ScholarPubMed
Lu, D, Wang, H, Yu, R, Yang, H, Zhao, Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect 2020;104:454–5CrossRefGoogle ScholarPubMed
Ye, MJ, Sharma, D, Rubel, KE, Lebo, NL, Burgin, SJ, Illing, EA et al. Droplet exposure risk to providers from in-office flexible laryngoscopy: a COVID-19 simulation. Otolaryngol Head Neck Surg 2020;164:93–6CrossRefGoogle ScholarPubMed
Workman, AD, Welling, DB, Carter, BS, Curry, WT, Holbrook, EH, Gray, ST et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 2020;10:798–805CrossRefGoogle ScholarPubMed
Kay, JK, Parsel, SM, Marsh, JJ, McWhorter, AJ, Friedlander, PL. Risk of SARS-CoV-2 transmission during flexible laryngoscopy: a systematic review. JAMA Otolaryngol Head Neck Surg 2020;146:851–6CrossRefGoogle ScholarPubMed
HSE.ie. Staying safe if you are at very high risk. In: https://www2.hse.ie/conditions/coronavirus/cocooning.html [12 October 2020]Google Scholar
Epidemiology of COVID-19 in Ireland. Report prepared by HPSC on 02/04/2020 for NPHET. In: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland/april2020/COVID-19%20Epidemiology%20report%20for%20NPHET%2002.04.2020%20-%20website.pdf [12 October 2020]Google Scholar
Epidemiology of COVID-19 in Ireland. Report prepared by HPSC on 02/07/2020 for National Public Health Emergency Team. In: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland/july2020/COVID-19_Daily_epidemiology_report_(NPHET)_02072020%20v1Website.pdf [12 October 2020]Google Scholar
Hanley, JA, Lippman-Hand, A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 1983;249:1743–5CrossRefGoogle ScholarPubMed
Pendolino, AL, Randhawa, PS, Andrews, PJ. How can we reduce the use of nasal endoscopy in the outpatient setting during COVID-19? Am J Rhinol Allergy 2020;34:857–8CrossRefGoogle ScholarPubMed
Radonovich, LJ Jr, Simberkoff, MS, Bessesen, MT, Brown, AC, Cummings, DAT, Gaydos, CA et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA 2019;322:824–33CrossRefGoogle ScholarPubMed
Rowan, NJ, Laffey, JG. Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from coronavirus disease (COVID19) pandemic – case study from the Republic of Ireland. Sci Total Environ 2020;725:138532CrossRefGoogle ScholarPubMed