ASENEM recommendations to restart Digestive Motility Laboratories activity during the COVID-19 pandemic

GENERAL

• 1. It is recommended to restart the activity of digestive motility tests gradually and to adapt it to the epidemiological situation of the SARS-CoV-2 infection, avoiding to postpone indefinitely those motility explorations with adequate indication.
• 2. At the moment there is NO concluding scientific evidence to support performing pre-procedure microbiological diagnostic tests for SARS-CoV-2 aiming at modifying the personal protective measures against the infection.

PRE-INTERVENTION

• 3. Question the patient before the appointment and before entering the laboratory about symptoms suggestive of COVID-19 and measure the temperature. If temperature over 37.2 ºC or suggestive symptoms re-schedule the test. (Appendix 1).
• 4. In patients with current COVID-19 infection confirmed by microbiological test or with suspected infection (compatible manifestations without microbiological confirmation) it is recommended to postpone the test until full recovery and completion of the recommended quarantine period.
• 5. In the case of patients who are probably immunized and asymptomatic patients with an unknown immunological status, it is NOT indicated to postpone the test.
• 6. In the case of asymptomatic patients who have had close, prolonged contact without the appropriate protection with an infected subject during the previous 2 weeks, it is recommended postponing the test for at least 2 weeks from the date of the risk contact.
• 7. Adjust the time assigned to the procedure considering the necessary measures to prevent COVID-19 infection. This will entail reducing the number of procedures and increasing the time assigned to each one.
• 8. Avoid crowding in waiting rooms. It is advisable that patients come alone or with only one accompanying person, and that the safety distance is maintained.
• 9. Provide the patient and his companion with the means to wash their hands with a hydroalcoholic solution upon entering the waiting room and when they leave the Motility Unit. Both must wear a mask during their stay at the hospital facilities (Appendix 2).
• 10. A healthcare provider with symptoms compatible with COVID-19, or with recent, close and prolonged contact with a COVID-19 patient, without the adequate protection, must NOT perform motility examinations until the disease is overcome, or the quarantine period has been completed.

INTERVENTION

• 11. Motility tests are only exceptionally urgent. In patients with current SARS-CoV-2 infection, it is recommended to postpone the tests until the disease is overcome and the recommended quarantine period has been completed.
• 12. In the exceptional case where the performance of a motility procedure cannot be postponed and the patient had a suspected or confirmed COVID-19 infection, it is recommended to perform the procedure in one of the endoscopy or surgical rooms enabled for such a purpose (ideally, rooms with negative pressure).
• 13. Use personal protection equipment (PPE) in all healthcare personnel involved in the performance of motility procedures (Appendix 3 and Appendix 4).

POST-INTERVENTION (Appendix 5)

• 14. Disinfection and reprocessing of reusable probes will be performed according to usual protocols.
• 15. Disinfect the pH /pH-impedance recorder and its accessories, stretcher, railing, and other elements with which the patient or explorer have had contact, using the viricidal agents recommended by the Healthcare Authorities.
• 16. The healthcare personnel must remove the PPE in the same room where the procedure was performed or in a room enabled for such a purpose, depending on the availability.
• 17. The single-use materials used must be discarded into a container for infectious biological waste (Category B, UN 3291).
• 18. It is advisable to contact the patient 15 days after the procedure, to keep a record of the activity and ensure it is being performed securely.

SPECIAL PROCEDURES

HYDROGEN BREATH TEST AND BREATH TESTS FOR HELICOBACTER PYLORI 

• 19. It is advisable to review and, if needed, adapt the protocols of collection, management, and analysis of samples to reduce the risk of direct transmission by aerosols and prevent the contamination of adjacent devices and areas.
• 20. During the sample collection process, special attention should be paid to undertake the necessary cautions, depending on the methodology and local characteristics, to prevent aerosol propagation.
• 21. The discarded materials must be thrown into a specific container for the processing of potentially contaminated biological products.
• 22. It is recommended that the instructor of the sample collection process wears an FFP2 (N95) or FFP3 mask and gloves. Both personnel who processes the sample and those who remain next to the patient during the exhaling maneuvers must wear a standard PPE.

INSTRUMENTAL TESTS FOR OROFARYNGEAL DYSPHAGIA

• 23. These tests have a high aerosol generation potential, so the same protection measures as for upper tract motility procedures are recommended.

Download: The Document

Download: Appendix 1, Appendix 2, Appendix 3,  Appendix 4,  Appendix 5,    Flowchart

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