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[秘鲁胃肠病学会关于避免通过消化内镜检查程序传播严重急性呼吸综合征冠状病毒2的建议]

[Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures].

作者信息

Prochazka Zá Rate Ricardo Arturo, Cabrera Cabrejos María Cecilia, Piscoya Alejandro, Vera Calderón Augusto Francisco

机构信息

Clínica Ricardo Palma. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú; Coordinador del Capítulo de Endoscopía, Sociedad de Gastroenterología del Perú. Lima, Perú.

Hospital Nacional Guillermo Almenara Yrigoyen. Lima, Perú; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú; Editor Asociado de la Revista de Gastroenterología del Perú. Lima, Perú.

出版信息

Rev Gastroenterol Peru. 2020 Jan-Mar;40(1):95-99.

Abstract

The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.

摘要

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引发了名为2019冠状病毒病(COVID-19)的疾病,目前该疾病正在一场迅速演变的大流行中传播。它可通过接触、飞沫和气溶胶传播,并且已从胃肠道分泌物和粪便中分离出来。在消化内镜检查期间,可能会通过上述任何一种机制发生传播。建议将消化内镜检查限制在以下情况:消化道出血、严重吞咽困难、消化道异物、伴有顽固性疼痛或胆管炎的胆道梗阻、假性囊肿或复杂性包裹性胰腺坏死、胃肠道梗阻以及随时间推移有病情恶化风险的病例。建议根据体温、症状和流行病学因素对患者进行筛查,以根据其感染风险进行分类。对于低风险患者的操作,工作人员必须穿戴一次性手术衣、手套、护目镜或面罩、标准外科口罩、一次性帽子、一次性鞋套。对于中高风险病例或确诊的COVID-19病例,应使用一次性防水手术衣、N95口罩或类似口罩以及双层手套来加强防护。在短缺情况下,可能有必要按照美国疾病控制与预防中心(CDC)关于穿戴、摘除和储存的建议,重复使用N95口罩最多5次,以防止二次接触污染。同样,所有防护设备都应按照CDC的建议穿戴和摘除。内镜检查室的工作人员应减至最少。上述人员必须每日测量体温,如果体温高于37.3℃,必须进行相应评估。每次操作后,担架和检查室表面应进行适当消毒。内镜的高水平消毒可杀灭SARS-CoV-2。

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