Post written by Mahesh Goenka, DM, FACG, FASGE, AGAF, from Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, India.
A prototype aerosol chamber was designed using a medical grade 4-mm thick polycarbonate sheet. The chamber has 4 holes, 2 on the head side used for endotracheal intubation and 2 on the side walls. The hole on left-side wall is used for endoscope introduction. These holes are covered with replaceable plastic stickers. The chamber is easily dismantled, cleaned, and re-assembled.
There has been a significant decline in the number of endoscopic examinations being performed all over the world during the current COVID pandemic. There is a perception that endoscopic procedures can create aerosol and facilitate viral transmission from patient to healthcare workers (HCW) and also the other way. A survey conducted by us showed the volume of endoscopies to have dipped to almost 10% in April-May 2020.
Standard preventive measures in endoscopy units include use of personal protective equipment (PPE), patient triaging and testing, reducing number of personnel in endoscopy suites, and thorough cleaning of surfaces. Aerosol boxes placed around patients’ heads have been used in intensive care units and operation theaters to allow safe endotracheal intubation by decreasing the spread of virus during intubation. We have, in this video, demonstrated a modified design of this chamber with an additional hole on side walls to allow endoscope introduction. We have found these aerosol chambers not only to be effective but easy to assemble and to clean in between uses. We now routinely use this technique in all our upper gastrointestinal endoscopic procedures including ERCP, particularly in patients where recent PCR test for COVID is not available or inconclusive.
Endoscopy may be more easily acceptable to patients in this COVID era with use of aerosol chambers or similar devices. We have further modified the design by placing the hole on the left side wall almost at the bottom of the chamber. We feel this allows smoother introduction of endoscope.
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