Safety practices for in‐office laryngology procedures during clinical reintroduction amidst COVID ‐19 2021 Haley Calcagno.pdf


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该【Safety practices for in‐office laryngology procedures during clinical reintroduction amidst COVID ‐19 2021 Haley Calcagno 】是由【碧痕】上传分享,文档一共【6】页,该文档可以免费在线阅读,需要了解更多关于【Safety practices for in‐office laryngology procedures during clinical reintroduction amidst COVID ‐19 2021 Haley Calcagno 】的内容,可以使用淘豆网的站内搜索功能,选择自己适合的文档,以下文字是截取该文章内的部分文字,如需要获得完整电子版,请下载此文档到您的设备,方便您编辑和打印。Received:17September2020Revised:5April2021Accepted:11May2021
DOI:
ORIGINALRESEARCH
Safetypracticesforin-officelaryngologyproceduresduring
clinicalreintroductionamidstCOVID-19
HaleyCalcagnoMD1|||
,2
1TheIndianaUniversitySchoolofMedicineandtheDepartmentofOtolaryngology-HeadandNeckSurgery,IndianaUniversity,Indianapolis,Indiana,USA
2TheDepartmentofSpeechandHearingSciences,IndianaUniversity,Bloomington,Indiana,USA
Correspondence
,DepartmentofAbstract
Otolaryngology-HeadandNeckSurgery,Objective:Describesafetypracticesforperformingin-officelaryngologyprocedures
FeslerHall,.,Suite
400,Indianapolis,IN46202,-introductionamidstthecoronavirusdisease2019(COVID-19)
Email:******@.
Methods:AnanonymoussurveyinQualtricswascreatedtoevaluatedemographics,
preproceduretesting,practicesettings,anesthesia,andpersonalprotectiveequip-
ment(PPE)useforfiveprocedurecategories(non-mucosal-traversinginjections,
mucosal-traversinginjections,endoscopywithoutsuction,endoscopywithsuction/
mucosalinterventionviaworkingchannel,andlaserviaworkingchannel).Thesurvey
wasemailedtotheFallVoiceCommunityonDocMatterandtomembersofthe
AmericanBroncho-EsophagologicalAssociation(ABEA)fromMaytoJune2020.
Results:Eighty-tworespondentswereanalyzed(responserate:10%).Respondents
representeddiverselocations,(71%)
orprivatepractices(16%),laryngologyfellowshiptraining(76%),andasignificant
practicedevotiontolaryngologyandbroncho--
introduction,-
ferredtotheORsettingformost,though36%preferredtheORforlaserprocedures.
TherewasapreferenceforpreproceduralSARS-Cov2testingforproceduresinvolv-
ingaworkingchannel(>67%),andtheseprocedureshadthehighestproportionof
respondentsdiscontinuingtheprocedureduetoCOVID-
anesthesiawerereported,
ofpersonalprotectiveequipmentutilizedweregloves(>95%)andN95masks(>67%).
Powered-airpurifyingrespiratorsandgeneralsurgicalmaskswereusedinfrequently.
Conclusions:Duringtheearlyre-introduction,respondentsreportedgenerallycon-
tinuingtoperformofficelaryngologyprocedures,whilegreatermucosalmanipulation
affecteddecisionstostopproceduresduetoCOVID-19,performpreprocedural
ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttribution-NonCommercial-NoDerivsLicense,whichpermitsuseanddistributioninany
medium,providedtheoriginalworkisproperlycited,theuseisnon-commercialandnomodificationsoradaptationsaremade.
©.
;1–
2CALCAGNOETAL.
SARS-Cov2testing,
predominatePPE.
LevelofEvidence:N/A.
KEYWORDS
coronavirus,COVID-19,laryngoscopy,otolaryngology,personalprotectiveequipment
1|INTRODUCTION(3)endoscopywithoutsuction(ENDOSCOPY-ALONE),(4)endoscopy
withsuctionand/ornon-laserinterventionviaaworkingchannelflex-
ThediseaseprocessescausedbySARSCov-2(COVID-19)requirediblelaryngoscope(NON-LASER),and(5)laserviaaworkingchannel
practicegroupsandhospitalsystemstomakeprofoundchangestoflexiblelaryngoscope(LASER).SeeAppendixS1formoredetails.
safetypracticesinanefforttoreducehealthcareproviderandpatientQuestionsaskedforeachprocedurecategoryincludedpreferences
-headforSARS-Cov-2testingbeforeprocedures,settingforprocedures,
andnecksurgeons,particularlylaryngologyprocedures,wereafocusmethodoflocalanesthesiaforprocedures,andpreferredpersonal
ofconcerngiventheaerosolizingnatureoftheseproceduresandprotectiveequipmentduringprocedures.
-
motereasonablesafetypracticesearlyintheCOVID-19pandemic,wasthroughDocMatter(DocMatterInc.,SanFrancisco,California),a
includingguidelines2andpositionstatements3fromtheAmericanweb-basedprofessionalsocialmediasiteforhealthcareproviders.
AcademyofOtolaryngology-HeadandNeckSurgery(AAO-HNS),asThesurveywaspostedMay2020tothe“FallVoice:EBTEvent
,4-6Additionally,AnnouncementSubgroup,”thensentdirectlytootolaryngology-head
inApril2020,theAAO-HNSpublishedvirtualwebinardataregardingandnecksurgeryprovidersthataremembersofthe“FallVoice
patientselection,personalprotectiveequipment(PPE)andendo-Community:Eat,Breathe,Talk”
scopicreprocessingconsensusdatafrom300providersfromthelar-wasinitiatedJune2020viaemailtothemembersoftheAmerican
,providersfacedBroncho-EsophagolocicalAssociation(ABEA).Toavoidduplicate
unprecedentedchallengesintheearlyphaseofclinicalre-introductionresponsesformembersofbothdistributionlists,theABEAdistribu-
aftertheshutdownofin-
specifically,in-
.
otolaryngology-headandnecksurgeonsprovidingin-officelaryngol-CollecteddatawasdownloadedfromQualtricsinMicrosoftExceland



addtothenecessaryframeworkfromwhichfuturesafetyprotocolswereperformedwithFisher'sexacttestanalysesinMicrosoftExcel.

knowledge,thisistheearliestcohortofaggregated,anonymousdata
reportedbyotolaryngology-headandnecksurgeonsregardingtheir3|RESULTS
safetypracticesforavarietyofin-officelaryngologyprocedures.
|Demographics
2|MATERIALSANDMETHODSFifty-sixof343providerscompletedthesurveyviaDocMatter
(responserate:56/343(16%)),and33of563providerscompletedthe
A30-pointanonymoussurveywasdeveloped,anddatawascollectedsurveyviatheABEA(responserate:33/563[6%]).Thecumulative
anonymouslythroughQualtrics(QualtricsSoftwareCompany,Provo,responseratewas10%.Sevenrespondentsindicatedtheyhadalready
UT).Asthesurveywasanonymouswithoutidentifiableinformation,completedthesurveyand4wereincomplete,sowereexcluded
ourinstitutiondidnotrequireaformalInstitutionalReviewBoard(n=82fordataanalysis).
,-
setting,anddetailedquestionsregardingsafetypracticesfor5groupsticesettingswereacademic(58/82)orprivatepracticewithoutan
oflaryngologyprocedures,whichwerecategorizedasfollows:academicaffiliation(13/82).Laryngologyandbroncho-esophagoscopy
(1)non-mucosaltraversinginjectionswithoutplacementofascopecomprisedmorethan50%oftheclinicalpracticeof78%ofrespon-
forvisualization(NON-MUCOSAL-INJECTIONS),(2)mucosal--ninerespondents(96%)werefromtheUnitedStates,
traversinginjectionswithoutascope(MUCOSAL-INJECTIONS),while3wereinternational(Israel,India,andBrazil,respectively).

TABLE1Demographicsofsurveyrespondents(N=,95%-).NON-LASERprocedureswithendos-
count)copywerenolongerperformedduetoCOVID-19atasignificantly
N%higherratecomparedtoENDOSCOPYALONE(10/64vs1/82,respec-
Timeinpracticetively;,95%-).Allproceduresinvolvingmanipu-
lationofthemucosa(MUCOSALINJECTIONSwithoutendoscopy,
0-
NON-LASERprocedures,andLASERprocedures)resultedinhigher
6-
numbersofrespondentshaltingtheprocedureorrequiringpreprocedure
10-
-Cov2testingwashighestforNON-LASER
20+
(36/54)andLASER(33/41)
Practicesetting
twocategoriesalsohadthehighestproportionofrespondentschoosing
-19(10/82foreach).
-Cov2testingforallproceduretypes
,
,%to
%ofrespondents.

Fellowshiptraining
|Setting

Themajorityofrespondentscontinuedtoperformprocedurecatego-

-INJECTIONSwithoutendoscopy

trendedtowardsahigherpreferencefortheregularpressureoperat-
Facialplastics&
ingroomsettingvsNON-MUCOSAL-INJECTIONS,butthisdidnot
Otology/
reachstatisticalsignificance(3/40vs0/64;,95%CI
-).Proceduresinvolvingmanipulationofthemucosa
(MUCOSALINJECTIONSwithoutendoscopy,NON-LASERproce-
Percentpracticedevotedtolaryngologyand/orbronchoesophagologydures,andLASERprocedures)hadmorerespondentsreporting
0%-25%-
26%-50%,including10/41preferring
51%-75%-pressurerooms.
>75%
|Personalprotectiveequipment
RespondentsfromtheUnitedStateswerefromatotalof24States,
includingWestern(n=4states),Midwestern(n=6states),
(n=10states),andNortheastern(n=4states)statesasdefinedbymostcommonformsofPPEutilizedweregloves(>95%forallproce-
)andeyeprotection(>84%forallprocedures).N95maskuse
CaliforniaandOhiohadthehighestnumberofrespondents(8each),increasedsignificantlywithMUCOSAL-INJECTIONSwithoutendos-
-MUCOSAL-INJECTIONS(%%;
,95%-).N95maskswerepreferredacross
allprocedures,and88%ofrespondentsreporteduseforallproce-
|ProcedurepracticesduresexcludingNON-MUCOSAL-INJECTIONSwithoutendoscopy.
Standardfacemaskuseforallotherproceduretypeswaslessthan
|StoppingproceduresduetoCOVID-19and35%.Powered-airpurifyingrespirators(PAPRs)andgeneralsurgical
preproceduralSARS-Cov2testingmaskswereusedinfrequentlyforallproceduretypes.
-INJECTIONSwithout
endoscopywerehaltedduetoCOVID-|Typeoflocalanesthesia
comparedtoNON-MUCOSALINJECTIONSwithoutendoscopy(7/47
vs1/65,respectively;,95%-).Ofthoseper-Mostrespondentsreportedutilizinganon-mucosaltraversingsubcutane-
formingtheMUCOSAL-INJECTIONSwithoutendoscopy,significantlyousinjectionoflocalanesthetic(45/64)forNON-MUCOSAL-INJECTIONS
morerequirednegativeSARS-Cov2testingpriortotheprocedurecom-%ofrespondentsutilizedasubcutaneous
paredtoNON-MUCOSALINJECTIONS(15/40vs9/64,respectively;andtrans-cutaneoustopicalinjectionoflocalanestheticforMUCOSAL-
4CALCAGNOETAL.
TABLE2Reportedsafetypracticesbyproceduretype(N=numbercount)
Non-mucosalEndoscopy
traversingMucosal-withsuction/
injections,traversingnon-laser
withoutscopeinjections,Endoscopy,interventionLaservia
(NON-withoutscopewithoutsuctionviaworkingworking
MUCOSAL(MUCOSAL(ENDOSCOPYchannelchannel
INJECTIONS)INJECTIONS)ALONE)(NON-LASER)(LASER)
N%N%N%N%N%
Performingprocedure?

No,stoppedduetoCOVID-
No,unrelatedtoCOVID-
Preproceduretesting?
Yes,
No,

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