Proactive measures for the pandemic COVID‐19 infection in outpatient clinics of Otolaryngology Department

Dear Editor,

The coronavirus disease 2019 (COVID‐19) has become a serious pandemic. According to a report from Wuhan, China, 40 (29%) health professionals were among the first 138 patients to be consecutively hospitalized. ¹ The reported symptoms of COVID‐19 included cough (67.8%), fever (43.8%), increased sputum production (33.7%), sore throat (13.9%), and nasal congestion (4.8%). ² Some patients had only hyposmia and dysgeusia as their initial symptoms. In particular, health care workers, such as otolaryngologists, who work on upper aerodigestive tract diseases, have the highest risk of contracting COVID‐19. Specifically, the first physicians to die from COVID‐19 in Wuhan and from severe acute respiratory syndrome (SARS) in Hong Kong pandemic were otolaryngologists. ³

Infection prevention protocols should be modified to ensure that otolaryngologists can appropriately adhere to them in their daily practice. Ideally, nonurgent head and neck procedures, including operations, should be postponed to limit the transmission of COVID‐19 from infected patients to health care workers. However, patients suspected of having foreign body impaction or head and neck cancers still require fiberscope examination. In our hospital, everyone must wear surgical masks, sanitize their hands, and have their body temperature checked at a quarantine station. ⁴ Before entering our facility, all patients' travel, occupation, contact, and cluster histories (TOCC) are enquired into and logged electronically. Those with a fever or with high‐risk TOCC profiles are not allowed to enter the hospital; they are referred to either an outdoor clinic or the Emergency Department.

Endoscopic examinations of the nose, sinuses, nasopharynx, oropharynx, hypopharynx, and larynx are common diagnostic procedures, but they generate aerosols. A study noted that for 83% of patients in Singapore, viral shedding from the nasopharynx continued for 7 days or longer. ⁵ Therefore, examiners should wear personal protective equipment, which includes N95 mask, a powered air‐purifying respirator, tight‐fitting goggles, a face shield, a gown, a disposable cap, shoe covers, and a pair of gloves.

Patients should be housed in private negative‐pressure wards. For alert patients, topical anesthesia should not be administered through a spray. Instead, we adopt a careful placement of pledgets soaked with decongestant and topical anesthetics in the patient's nose before examination. This method avoids triggering the sneezing and coughing reflex in patients. Patients are asked to use a surgical mask to cover their mouth when we insert the fiberscope through their nose during the procedure. We prefer using a video monitoring system to prevent close contact with the patients. The other benefit of using video is that the examiner can stand at the side rather than the front of the patient, thus avoiding contact with the aerosol generated during the procedure. After examinations, the environment and all used equipment must be disinfected. It is mandatory to wash hands with soap and water or alcohol‐based hand rub before and after all patients' interaction.

We discuss fiberscope use in otolaryngology in the context of the COVID‐19 pandemic. We also discuss the COVID‐19 protection measures mandated by our Department of Otolaryngology; these measures protect the clinical workforce from COVID‐19 infection.

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.