Editor
During the COVID-19 pandemic, numbers of patients with colorectal cancer needing a stoma are likely to increase. The recommendations of scientific societies encourage interventions with a lower risk of complications, short recovery time and less likelihood of ICU admission (particularly Hartmann's procedure) in these patients, especially those who test positive for COVID-191–3.
At present, patients may have great difficulty handling the paperwork required to obtain stoma bags and aids that prevent peristomal skin complications from the National Health System. Furthermore, an additional problem both for patients and caregivers is the possible withdrawal of medical devices from pharmacies due to restrictive measures on mobility.
The Italian government has requested that regional administrations protect patients with disabilities, and many regions have introduced self-renewal of medical prescriptions, strengthened regional services to avoid hospital attendance and provided for direct home delivery of prosthetic devices. These solutions are proving useful and we recommend they be established by all countries.
Viral RNA has been detected in gastrointestinal secretions and faeces, so faecal excretion could represent a further potential route of viral transmission2. For this reason, adherence to proper handwashing, use of antiseptic foam, as well as use of appropriate personal protective equipment should be strictly enforced for patients, stoma nurses and caregivers4,5. Moreover, the use of stool-containment bags with a safe locking system is recommended to prevent accidental spillage of intestinal material. In COVID-19-positive stoma patients, negative pressure rooms should be considered during procedures, if available.
In conclusion, the COVID-19 pandemic is worsening disability in stoma patients. Only good synergy between adequate government provisions and correct stoma care practices can help overcome this challenging situation.
References
- 1. COVIDSurg Collaborative . Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; 10.1002/bjs.11646 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Gallo G, La Torre M, Pietroletti R, Bianco F, Altomore DF, Pucciarelli Set al. Italian Society of Colorectal Surgery recommendations for good clinical practice in colorectal surgery during the novel coronavirus pandemic. Tech Coloproctol 2020; 24: 501–505. 10.1007/s10151-020-02209-6 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBSet al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 10.1002/bjs.11670 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Ives J, Huxtable R. Surgical ethics during a pandemic: moving into the unknown? Br J Surg 2020; 10.1002/bjs.11638 [Epub ahead of print]. [DOI] [PubMed] [Google Scholar]
- 5. Di Marzo F, Sartelli M, Cennamo R, Toccafondi G, Coccolini F, La Torre Get al. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2). Br J Surg 2020; 10.1002/bjs.11652 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]