Endoscopy
DOI: 10.1055/a-1220-6024
E–Videos

Coronavirus disease outbreak: a simple infection prevention measure using a surgical mask during endoscopy

Hirotsugu Maruyama
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Akira Higashimori
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Kei Yamamoto
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Akinobu Nakata
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Yuki Ishikawa-Kakiya
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Masafumi Yamamura
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Yasuhiro Fujiwara
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
› Author Affiliations
 

Coronavirus disease (COVID-19) transmission occurs primarily through direct contact or air droplets [1] [2], and endoscopic procedures are high risk. In this era of “with COVID-19,” establishing simple infection prevention measures within an endoscopy department to protect both patients and personnel is strongly recommended. Hence, we proposed a simple method using a modified surgical mask. We made a hole (10 mm diameter) in the center of a surgical mask ([Fig. 1]). Next, simulated endoscopy was performed with and without the modified surgical mask using a mannequin with the mouthpiece in place ([Video 1]).

Zoom Image
Fig. 1 The modified surgical mask.

Video 1 A simple infection prevention measure using a modified surgical mask during endoscopy.


Quality:

Cough was simulated using a 0.4-MPa pressure accumulation sprayer containing 10 mL of fluorescent dye [3] [4] [5]. An endoscopist (height 173 cm) wearing standard personal protective equipment (PPE) performed upper gastrointestinal endoscopy. A nurse (height 163 cm) wearing standard PPE stood on the other side of the “patient.” The scattered dye droplets produced by the simulated cough were visualized using ultraviolet light.

Without the modified surgical mask, contamination of the floor occurred within approximately 1.5 m from the bed, and the dye was clearly identified on the gloves, right arm, upper chest, abdomen, and shoe covers of the endoscopist ([Fig. 2]). There was no dye on the endoscopist’s eye shield, mask, or cap. The dye was identified on the gloves of the nurse ([Fig. 3]). When the modified surgical mask was worn by the “patient,” excessive amounts of dye were found inside the mask ([Fig. 4]). There was no contamination of the floor, and only a minimum amount of dye was found on the endoscopist’s upper chest and abdomen ([Fig. 5]). No dye was found on the nurse.

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Fig. 2 Contamination of the endoscopist by scattered dye droplets, visualized using ultraviolet light, when the modified surgical mask was not used. a Contamination of the endoscopist’s gloves, right arm, upper chest, and abdomen. b The shoe covers.
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Fig. 3 The dye was identified on the gloves of the nurse when the modified surgical mask was not used.
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Fig. 4 Excessive amounts of dye were found inside the modified surgical mask when worn by the “patient.”
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Fig. 5 Minimal contamination of the endoscopist by scattered dye droplets, visualized using ultraviolet light, when the modified surgical mask was used.

In summary, upper gastrointestinal endoscopy could be performed on a “patient” wearing a modified surgical mask. This method can substantially reduce contamination by splash and aerosol droplets produced by patients during endoscopy, and is simple and cost-effective.

Endoscopy_UCTN_Code_TTT_1AU_2AC

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Hirotsugu Maruyama, MD, PhD
Department of Gastroenterology
Osaka City University Graduate School of Medicine
1-4-3, Asahimachi
Abeno-ku, Osaka 545-8585
Japan   
Fax: +81-66-6453813   

Publication History

Publication Date:
20 August 2020 (online)

© Georg Thieme Verlag KG
Stuttgart · New York


Zoom Image
Fig. 1 The modified surgical mask.
Zoom Image
Fig. 2 Contamination of the endoscopist by scattered dye droplets, visualized using ultraviolet light, when the modified surgical mask was not used. a Contamination of the endoscopist’s gloves, right arm, upper chest, and abdomen. b The shoe covers.
Zoom Image
Fig. 3 The dye was identified on the gloves of the nurse when the modified surgical mask was not used.
Zoom Image
Fig. 4 Excessive amounts of dye were found inside the modified surgical mask when worn by the “patient.”
Zoom Image
Fig. 5 Minimal contamination of the endoscopist by scattered dye droplets, visualized using ultraviolet light, when the modified surgical mask was used.