Bronchoscopy masks mitigate aerosols during upper gastrointestinal endoscopies

Abstract

Background and study aims Upper gastrointestinal endoscopies are considered aerosol-generating procedures (AGP) that risk spread of airborne diseases such as SARS-CoV-2. We aimed to investigate where clinically approved bronchoscopy masks applied to patients during esophagogastroduodenoscopies can mitigate spread of aerosols and droplets.

Patients and methods This study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room and used a particle counter to measure size and number of particles 10 cm from the mouths of 49 patients undergoing upper gastrointestinal endoscopies, of whom 12 wore bronchoscopy masks and 37 did not (controls). Particle counts in the aerosol (≤ 5 µm diameter) and droplet (> 5 µm-diameter) size ranges were measured and averaged over the duration of procedures.

Results The use of bronchoscopy masks offers a 47% reduction (P = 0.01) in particle count for particles < 5 μm in diameter over the procedure duration (aerosols).

Conclusions Bronchoscopy masks or similar are a simple, low-cost mitigation technique that can be used during outbreaks of respiratory diseases such as COVID-19 to improve safety and reduce fallow times.

Keywords

Quality and logistical aspects - Hygiene - Endoscopy Upper GI Tract - Quality management

Publikationsverlauf

Eingereicht: 05. Mai 2023

Angenommen nach Revision: 17. August 2023

Accepted Manuscript online:
11. September 2023

Artikel online veröffentlicht:
17. Oktober 2023

• References

• 1 Chan SM, Ma TW, Chong MKC. et al. A proof of concept study: esophagogastroduodenoscopy is an aerosol-generating procedure and continuous oral suction during the procedure reduces the amount of aerosol generated. Gastroenterology 2020; 159: 1949-1951
• 2 Gregson FKA, Shrimpton AJ, Hamilton F. et al. Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy. Gut 2022; 71: 871-878
• 3 Phillips F, Crowley J, Warburton S. et al. Aerosol and droplet generation in upper and lower GI endoscopy: whole procedure and event-based analysis. Gastrointest Endosc 2022; 96: 603-611
• 4 Wilson N, Corbett S, Tovey E. Airborne transmission of COVID-19. BMJ 2020; 20: m3206
• 5 World Health Organization. Infection prevention and control during health care when coronavirus disease (‎COVID-19)‎ is suspected or confirmed. https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-2021.1
• 6 Sagami R, Nishikiori H, Sato T. et al. Endoscopic shield: barrier enclosure during the endoscopy to prevent aerosol droplets during the COVID-19 pandemic. VideoGIE 2020; 5: 445-448
• 7 Kikuchi D, Ariyoshi D, Suzuki Y. et al. Possibility of new shielding device for upper gastrointestinal endoscopy. Endosc Int Open 2021; 9: E1536-E1541
• 8 Marchese M, Capannolo A, Lombardi L. et al. Use of a modified ventilation mask to avoid aerosolizing spread of droplets for short endoscopic procedures during coronavirus COVID-19 outbreak. Gastrointest Endosc 2020; 92: 439-440
• 9 Bojórquez A, Larequi FJZ, Betés MT. et al. Commercially available endoscopy facemasks to prevent aerosolizing spread of droplets during COVID-19 outbreak. Endosc Int Open 2020; 8: E815-E816
• 10 Suzuki S, Gotoda T, Ikehara H. et al. Minimizing endoscopist facial exposure to droplets: Optimal patient-endoscopist distance and use of a barrier device. J Gastroenterol Hepatol 2021; 36: 1051-1056
• 11 Phillips F, Crowley J, Warburton S. et al. Air filtration mitigates aerosol levels both during and after endoscopy procedures. DEN Open 2023; 3: e231
• 12 Han ZY, Weng WG, Huang QY. Characterizations of particle size distribution of the droplets exhaled by sneeze. J R Soc Interface 2013; 10: 20130560
• 13 Tang JW, Nicolle AD, Klettner CA. et al. Airflow dynamics of human jets: sneezing and breathing - potential sources of infectious aerosols. PLoS One 2013; 8: e59970
• 14 Hecker JG, He J, Rochlin R. et al. Measuring aerosols in the operating theatre and beyond using a real-time sensor network. Anaesthesia 2022; 77: 1097-1105
• 15 Gregson FKA, Sheikh S, Archer J. et al. Analytical challenges when sampling and characterising exhaled aerosol. Aerosol Sci Technol 2022; 56: 160-175
• 16 Morawska L, Johnson GR, Ristovski ZD. et al. Size distribution and sites of origin of droplets expelled from the human respiratory tract during expiratory activities. J Aerosol Sci 2009; 40: 256-269
• 17 Rayner RK. Bootstrapping p values and power in the first-order autoregression: a Monte-Carlo investigation. J Bus Econ Stat 1990; 8: 251-623
• 18 Gao Y, Xie J, Ye LS. et al. Negative-pressure isolation mask for endoscopic examination during the Coronavirus disease 2019 pandemic: a randomized controlled trial. Clin Transl Gastroenterol 2021; 12: e00314